進行性に増悪をきたし血管内治療を施行した右内頚動脈閉塞の1例

A ７７-year-old man was admitted to our hospital in July ２００９ with monoparesis of the left upper extremity. His magnetic resonance images（MRI）demonstrated multiple infarction in the right temporoparietal lobe, and his emergent cerebral angiography revealed total occlusion of the right internal carotid artery（ICA）at the origin. We diagnosed atherothrombotic infarction and started to treat with antiplatelet drugs. But, his symptoms were gradually progressing despite medical treatment and his MRI showed an enlargement of ischemic lesion８days after admission. Because the hemodynamic enlargement due to ICA occlusion and DWI-PWI mismatch was detected, we performed emergent PTA（percutaneous transluminal angioplasty）and CAS（carotid artery stent placement）at that time. The ICA was completely recanalized without any complications. His symptoms were getting better, and his cerebral blood flow improved at rest on single photon emission computed tomography（SPECT）６days after treatment. He was transferred to another hospital１７days after the onset. This case experience suggests that endovascular revascularization can be considered as potential treatment for symptomatic ICA occlusion based on atherosclerosis even in the subacute stage of the stroke patients.