High flowバイパス 20年後のグラフト血管に発生した破裂部分血栓化巨大動脈瘤の治療例

Abstract

Cerebral revascularization with high-flow extracranial-intracranial (EC-IC) bypass is generally indicated in patients with complex intracranial aneurysms. This is the first reported case of aneurysm formation followed by rupture occurring on the graft itself, which was constructed to treat a patient with a giant internal carotid artery (ICA) aneurysm. A-78-year-old woman who had undergone right EC-IC bypass using a saphenous vein graft and ligation of the right cervical ICA to treat an unruptured right ICA giant aneurysm 20 years earlier presented with a subarachnoid hemorrhage (SAH). Computed tomography (CT) on admission revealed a ring-like mass in the right temporal lobe with an SAH. Angiography showed a fusiform aneurysmal formation on the graft just before the anastomotic site. We initially performed detachable coil embolization of the aneurysm with a stent in the acute stage. Next, endovascular trapping of the parent artery (saphenous vein graft) and removal of intraaneurysmal thrombus were performed, after we created a new high-flow EC-IC bypass using a radial artery. We report this case along with a review of the literature.