出口 亜弥¹, 河野 浩之², 稲富 雄一郎², 山川 津恵子¹, 久木野 拓己¹, 山本 多美¹, 泉田 恵美¹, 志水 秋一¹, 米原 敏郎²

Aya DEGUCHI¹, Hiroyuki KAWANO², Yuichiro INATOMI², Tsueko YAMAKAWA¹, Takumi KUKINO¹, Tami YAMAMOTO¹, Megumi IZUMIDA¹, Syuichi SHIMIZU¹, Toshiro YONEHARA²

¹済生会熊本病院中央検査部神経超音波検査室, ²済生会熊本病院脳卒中センター神経内科

¹Department of Laboratory Center, Division of Neurosonology, Saiseikai Kumamoto Hospital, ²Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital

キーワード : vertebral artery, VA stump syndrome, duplex ultrasound, stroke

目的：vertebral artery （VA） stump syndromeの報告例は少ない．本病態における頸部血管エコーの所見を検討した．対象と方法：対象は，2005年9月から2011年5月に当院に入院し，VA stump syndromeの診断に至った7症例（男性4例，平均58歳）である．頸部血管エコーを実施し，頭部MRA，3D-CT血管造影，脳血管造影の所見と比較した．結果：入院時の頸部血管エコーで， 7例中3例で可動性血栓による閉塞，1例で閉塞遠位部に浮遊する可動性血栓，1例で閉塞遠位部の血流うっ滞を認めた．VA椎体内の血流は4例で順行性であり，流速が低く収縮期の立ち上がりがなだらかなpost-stenotic patternを呈していた．残り3例は収縮期逆行性のto-and-fro patternであった．また，4例で側副血行路とその流入部位も確認できた．頭部MRAでは2例で椎骨脳底動脈系に明らかな血管病変は認めなかった．結論：頸部血管エコーは，VA起始部の閉塞部位の性状やVA椎体内の血流パターン，側副血行路を評価できるので，VA stump syndromeのスクリーニングに有用である．

Purpose: Vertebral artery (VA) stump syndrome is described as one of the causes of posterior circulation ischemic stroke associated with VA occlusion. There are no reports of findings yielded by duplex ultrasound for diagnosing VA stump syndrome. The aim of the present study was to clarify the utility of duplex ultrasound for diagnosing VA stump syndrome. Subjects and Methods: Patients with acute posterior circulation stroke and VA proximal occlusion were diagnosed with VA stump syndrome. All patients underwent both duplex ultrasound and MRA unless contraindicated. CT angiography or conventional angiography was performed if possible. Results and Discussion: Seven patients were enrolled. On duplex ultrasound, an antegrade flow pattern was observed in four patients, although the culprit VA was occluded in the proximal portion. A to-and-fro pattern and delayed systolic upstroke flow were observed in the culprit VA in three and four patients, respectively. The collateral flow could be detected on duplex ultrasonography in four patients. Brain MRA revealed no abnormal findings in the vertebrobasilar arteries in two patients. Conclusion: Duplex ultrasound is useful for diagnosing VA stump syndrome, because duplex ultrasound can be used to evaluate flow and intravascular stasis.