脳梗塞の原因として内頸動脈内血栓が関与した1例
症例は49歳の男性．全失語，右片麻痺を主訴に搬送された．頭部MRIで左前大脳動脈・中大脳動脈領域に超急性期梗塞を認め，MRAでは左A2部・M2部の閉塞が示唆された．t-PAを投与したが症状は改善せず，頸動脈エコーで左内頸動脈起始部に6×7×17 mmの巨大血栓を認め，脳梗塞の原因と考えられた．抗凝固療法を開始後に血栓は徐々に縮小し最終的に消失した．内頸動脈内血栓（internal carotid thrombus; ICT）に対しては抗凝固療法が有効であり，その効果の確認には頸動脈エコーが有用であった1例を報告する．...
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| Published in | 臨床神経学 Vol. 57; no. 1; pp. 14 - 20 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-000951 |
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| Abstract | 症例は49歳の男性．全失語，右片麻痺を主訴に搬送された．頭部MRIで左前大脳動脈・中大脳動脈領域に超急性期梗塞を認め，MRAでは左A2部・M2部の閉塞が示唆された．t-PAを投与したが症状は改善せず，頸動脈エコーで左内頸動脈起始部に6×7×17 mmの巨大血栓を認め，脳梗塞の原因と考えられた．抗凝固療法を開始後に血栓は徐々に縮小し最終的に消失した．内頸動脈内血栓（internal carotid thrombus; ICT）に対しては抗凝固療法が有効であり，その効果の確認には頸動脈エコーが有用であった1例を報告する． |
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| AbstractList | 症例は49歳の男性．全失語，右片麻痺を主訴に搬送された．頭部MRIで左前大脳動脈・中大脳動脈領域に超急性期梗塞を認め，MRAでは左A2部・M2部の閉塞が示唆された．t-PAを投与したが症状は改善せず，頸動脈エコーで左内頸動脈起始部に6×7×17 mmの巨大血栓を認め，脳梗塞の原因と考えられた．抗凝固療法を開始後に血栓は徐々に縮小し最終的に消失した．内頸動脈内血栓（internal carotid thrombus; ICT）に対しては抗凝固療法が有効であり，その効果の確認には頸動脈エコーが有用であった1例を報告する． |
| Author | 坂井, 翔建 杉森, 宏 上床, 武史 石束, 光司 |
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| References | 22) Takayama K, Taoka T, Nakagawa H, et al. Carotid artery stenosis with intraluminal thrombus discovered during carotid artery stenting. Jpn J Radiol 2009;27:367-370. 18) Bhatti AF, Leon LR Jr, Labropoulos N, et al. Free-floating thrombus of the carotid artery: literature review and case reports. J Vasc Surg 2007;45:199-205. 17) Vassileva E, Daskalov M, Stamenova P. Free-floating thrombus in stroke patients with nonstenotic internal carotid artery-an ultrasonographic study. J Clin Ultrasound 2015;43:34-38. 14) Karapanayiotides T, Kouskouras K, Ioannidis P, et al. Internal Carotid Artery Floating Thrombus in Relapsing Polychondritis. J Neuroimaging 2015;25:142-144. 16) Thornhill RE, Lum C, Jaberi A, et al. Can shape analysis differentiate free-floating internal carotid artery thrombus from atherosclerotic plaque in patients evaluated with CTA for stroke or transient ischemic attack? Acad Radiol 2014;21:345-354. 26) Tan AP, Taneja M, Seah BH, et al. Acute free-floating carotid artery thrombus causing stroke in a young patient: unique etiology and management using endovascular approach. J Stroke Cerebrovasc Dis 2014;23:e437-439. 4) Yamagami H, Kitagawa K, Ohtsuki T, et al. Embolic cerebral infarction caused by intraluminal thrombus in the carotid siphon successfully treated with combination of anticoagulant and antiplatelet drugs. Circ J 2005;69:1147-1149. 13) Teodoro T, Geraldes R, Pinho e Melo T. Symptomatic internal carotid artery thrombosis in acute carbon monoxide intoxication. Am J Emerg Med 2014;32:684.e5-e6. 24) 大多和賢登，錦古里武志，渡辺賢一ら，頚動脈浮遊血栓に対し頚動脈エコーガイド下に血管内治療を行った1例. No Shinkei Geka 2016;44:489-494. 9) Choi HY, Ye BS, Ahn SH, et al. Characteristics and the fate of intraluminal thrombus of the intracranial and extracranial cerebral arteries in acute ischemic stroke patients. Eur Neurol 2009;62:72-78. 7) Elijovich L, Mainali S, Doss V, et al. Medical management of free-floating carotid thrombus. Clin Neurol Neurosurg 2013;115:1532-1535. 2) Karapurkar AP, Singh R, Teelala SM, et al. Free-floating thrombus in a stenotic supraclinoid left internal carotid artery. BMJ Case Rep 2016;2016. pii: bcr2015213067. 5) Cortés-Vicente E, Delgado-Mederos R, Bellmunt S, et al. Stroke caused by a myxoma stenosing the common carotid artery. J Stroke Cerebrovasc Dis 2015;24:e87-e89. 25) Santoro L, Schinzari F, Di Veronica A, et al. Carotid free-floating thrombus in woman with meningioma: a case report and review of the literature. Eur Rev Med Pharmacol Sci 2015;19:1442-1445. 1) Tateishi Y, Tsujino A, Hamabe J, et al. “Snake Fang” sign without carotid stenosis on duplex ultrasonography indicates high risk of artery-to-artery embolic stroke. J Neuroimaging 2014;24:407-410. 10) Batur Caglayan HZ, Nazliel B, Irkec C, et al. Iron-deficiency anemia leading to transient ischemic attacks due to intraluminal carotid artery thrombus. Case Rep Neurol Med 2013;2013:813415. 19) Vellimana AK, Kadkhodayan Y, Rich KM, et al. Symptomatic patients with intraluminal carotid thrombus: outcome with a strategy of initial anticoagulation. J Neurosurg 2013;118:34-41 23) 中野正紹，緒方利安，矢坂正弘ら．頸部血管エコー検査でoscillating thrombusを経時的に観察し得た心原性脳塞栓症の1例．脳卒中 2007;29:474-478. 11) Mahalangikar R, Kumar A, Sharma BS. Transorbital penetrating intracranial injury with an umbrella wire causing cavernous internal carotid artery injury and thrombosis. World Neurosurg 2016;86:513.e15-e18. 8) Buchan A, Gates P, Pelz D, et al. Intraluminal thrombus in the cerebral circulation. Stroke 1988;19:681-687. 15) Jaberi A, Lum C, Stefanski P, et al. Computed tomography angiography intraluminal filling defect is predictive of internal carotid artery free-floating thrombus. Neuroradiology 2014;56:15-23. 27) Vidale S, Bellocchi S, Caronno R, et al. Intra-operative detection of carotid free-floating thrombus in a symptomatic patient with a methylenetetrahydrofolate reductase gene mutation. Case report and literature review. Acta Neurochir(Wein) 2013;155:1125-1126. 21) Kwon TH, Kim BM, Nam HS, et al. Carotid stenting in acute ischemic stroke patients with intraluminal thrombus. Neuroradiology 2011;53:773-778. 6) Graham R, Blaszczynski M. Spontaneous free floating carotid artery thrombosis. BMJ Case Rep 2013;2013. pii: bcr2013008710. 20) Tsumoto T, Terada T, Tsuura M, et al. Carotid artery stenting for stenosis with intraluminal thrombus. Neuroradiology 2006;48:54-59. 12) Karnecki K, Jankowski Z, Kaliszan M. Direct penetrating and indirect neck trauma as a cause of internal carotid artery thrombosis and secondary ischemic stroke. J Thromb Thrombolysis 2014;38:409-415. 3) Naganuma M, Inatomi Y, Kobayashi O, et al. Reappearance of free-floating carotid thrombus after discontinuation of anticoagulant therapy. J Stroke Cerebrovasc Dis 2015;24:e45-e47. |
| References_xml | – reference: 27) Vidale S, Bellocchi S, Caronno R, et al. Intra-operative detection of carotid free-floating thrombus in a symptomatic patient with a methylenetetrahydrofolate reductase gene mutation. Case report and literature review. Acta Neurochir(Wein) 2013;155:1125-1126. – reference: 23) 中野正紹，緒方利安，矢坂正弘ら．頸部血管エコー検査でoscillating thrombusを経時的に観察し得た心原性脳塞栓症の1例．脳卒中 2007;29:474-478. – reference: 11) Mahalangikar R, Kumar A, Sharma BS. Transorbital penetrating intracranial injury with an umbrella wire causing cavernous internal carotid artery injury and thrombosis. World Neurosurg 2016;86:513.e15-e18. – reference: 17) Vassileva E, Daskalov M, Stamenova P. Free-floating thrombus in stroke patients with nonstenotic internal carotid artery-an ultrasonographic study. J Clin Ultrasound 2015;43:34-38. – reference: 13) Teodoro T, Geraldes R, Pinho e Melo T. Symptomatic internal carotid artery thrombosis in acute carbon monoxide intoxication. Am J Emerg Med 2014;32:684.e5-e6. – reference: 19) Vellimana AK, Kadkhodayan Y, Rich KM, et al. Symptomatic patients with intraluminal carotid thrombus: outcome with a strategy of initial anticoagulation. J Neurosurg 2013;118:34-41 – reference: 8) Buchan A, Gates P, Pelz D, et al. Intraluminal thrombus in the cerebral circulation. Stroke 1988;19:681-687. – reference: 16) Thornhill RE, Lum C, Jaberi A, et al. Can shape analysis differentiate free-floating internal carotid artery thrombus from atherosclerotic plaque in patients evaluated with CTA for stroke or transient ischemic attack? Acad Radiol 2014;21:345-354. – reference: 12) Karnecki K, Jankowski Z, Kaliszan M. Direct penetrating and indirect neck trauma as a cause of internal carotid artery thrombosis and secondary ischemic stroke. J Thromb Thrombolysis 2014;38:409-415. – reference: 25) Santoro L, Schinzari F, Di Veronica A, et al. Carotid free-floating thrombus in woman with meningioma: a case report and review of the literature. Eur Rev Med Pharmacol Sci 2015;19:1442-1445. – reference: 22) Takayama K, Taoka T, Nakagawa H, et al. Carotid artery stenosis with intraluminal thrombus discovered during carotid artery stenting. Jpn J Radiol 2009;27:367-370. – reference: 20) Tsumoto T, Terada T, Tsuura M, et al. Carotid artery stenting for stenosis with intraluminal thrombus. Neuroradiology 2006;48:54-59. – reference: 26) Tan AP, Taneja M, Seah BH, et al. Acute free-floating carotid artery thrombus causing stroke in a young patient: unique etiology and management using endovascular approach. J Stroke Cerebrovasc Dis 2014;23:e437-439. – reference: 7) Elijovich L, Mainali S, Doss V, et al. Medical management of free-floating carotid thrombus. Clin Neurol Neurosurg 2013;115:1532-1535. – reference: 14) Karapanayiotides T, Kouskouras K, Ioannidis P, et al. Internal Carotid Artery Floating Thrombus in Relapsing Polychondritis. J Neuroimaging 2015;25:142-144. – reference: 6) Graham R, Blaszczynski M. Spontaneous free floating carotid artery thrombosis. BMJ Case Rep 2013;2013. pii: bcr2013008710. – reference: 9) Choi HY, Ye BS, Ahn SH, et al. Characteristics and the fate of intraluminal thrombus of the intracranial and extracranial cerebral arteries in acute ischemic stroke patients. Eur Neurol 2009;62:72-78. – reference: 18) Bhatti AF, Leon LR Jr, Labropoulos N, et al. Free-floating thrombus of the carotid artery: literature review and case reports. J Vasc Surg 2007;45:199-205. – reference: 2) Karapurkar AP, Singh R, Teelala SM, et al. Free-floating thrombus in a stenotic supraclinoid left internal carotid artery. BMJ Case Rep 2016;2016. pii: bcr2015213067. – reference: 3) Naganuma M, Inatomi Y, Kobayashi O, et al. Reappearance of free-floating carotid thrombus after discontinuation of anticoagulant therapy. J Stroke Cerebrovasc Dis 2015;24:e45-e47. – reference: 21) Kwon TH, Kim BM, Nam HS, et al. Carotid stenting in acute ischemic stroke patients with intraluminal thrombus. Neuroradiology 2011;53:773-778. – reference: 1) Tateishi Y, Tsujino A, Hamabe J, et al. “Snake Fang” sign without carotid stenosis on duplex ultrasonography indicates high risk of artery-to-artery embolic stroke. J Neuroimaging 2014;24:407-410. – reference: 10) Batur Caglayan HZ, Nazliel B, Irkec C, et al. Iron-deficiency anemia leading to transient ischemic attacks due to intraluminal carotid artery thrombus. Case Rep Neurol Med 2013;2013:813415. – reference: 15) Jaberi A, Lum C, Stefanski P, et al. Computed tomography angiography intraluminal filling defect is predictive of internal carotid artery free-floating thrombus. Neuroradiology 2014;56:15-23. – reference: 4) Yamagami H, Kitagawa K, Ohtsuki T, et al. Embolic cerebral infarction caused by intraluminal thrombus in the carotid siphon successfully treated with combination of anticoagulant and antiplatelet drugs. Circ J 2005;69:1147-1149. – reference: 24) 大多和賢登，錦古里武志，渡辺賢一ら，頚動脈浮遊血栓に対し頚動脈エコーガイド下に血管内治療を行った1例. No Shinkei Geka 2016;44:489-494. – reference: 5) Cortés-Vicente E, Delgado-Mederos R, Bellmunt S, et al. Stroke caused by a myxoma stenosing the common carotid artery. J Stroke Cerebrovasc Dis 2015;24:e87-e89. |
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| Snippet | 症例は49歳の男性．全失語，右片麻痺を主訴に搬送された．頭部MRIで左前大脳動脈・中大脳動脈領域に超急性期梗塞を認め，MRAでは左A2部・M2部の閉塞が示唆された．t-PAを投与したが症状は改善せず，頸動脈エコーで左内頸動脈起始部に6×7×17... |
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| SubjectTerms | 内頸動脈内血栓 抗凝固療法 頸動脈エコー |
| Title | 脳梗塞の原因として内頸動脈内血栓が関与した1例 |
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