37. 内頸動脈領域の巨大脳動脈瘤に対するdetachable balloon catheterを用いた内頸動脈閉塞術

概要

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The balloon Matas' test (temporary occlusion of the internal carotid artery with a 4.8F Swan-Ganz type double lumen catheter) was performed on four patients with large to giant aneurysms of the internal carotid artery, and two of them were treated by means of internal carotid arterial occlusion with Debrun's detachable balloon catheter. In one patient, neurological deterioration (lowering of the consciousness level, aphasia and right hemiparesis) appeared just after temporary occlusion of the left internal carotid artery and it disappeared just after reopening the internal carotid artery. This patient did not show any neurological deterioration due to the classical Matas' test (compression of the common carotid artery with the fingers). This shows the efficiency of the balloon Matas' test. The other three patients tolerated the balloon Matas' test for 15-70 minutes and no neurological deterioration was found during the examination. Two of these three patients underwent permanent internal carotid arterial occlusion with Debrun's detachable balloon catheter. The internal carotid artery was occluded just at the proximal part of the canalicular portion, and the detached balloon was inflated a little more to avoid migration of the balloon. These aneurysms were confirmed to be occluded with thrombus formation from the follow-up computerized tomographic findings. No TIA or cerebral infarction was noted during the one-to-six-month follow-up period.