非細菌性血栓性心内膜炎が原因の脳塞栓症に対し，血栓回収療法を試みた1剖検例
症例は，73歳女性．十二指腸乳頭部癌の末期で外来通院中，突然の右片麻痺で救急搬送された．頭部MRIで，左中大脳動脈領域に拡散低下を認め，MRAで左内頸動脈はサイフォン部までしか描出されなかった．血小板数が低値で，血栓溶解療法の禁忌に該当したため，血栓回収療法を行った．血栓吸引を試みるも，有効再開通を得られなかった．その後，多臓器不全に至り死亡した．病理では，僧帽弁に血小板主体の白色血栓が付着し，非細菌性血栓性心内膜炎からの脳塞栓症と診断した．非細菌性血栓性心内膜炎による脳梗塞では，白色血栓であることが多く，硬いことが予想され，この点を考慮しデバイスを選択する必要がある．...
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| Published in | 臨床神経学 Vol. 59; no. 4; pp. 195 - 199 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001252 |
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| Abstract | 症例は，73歳女性．十二指腸乳頭部癌の末期で外来通院中，突然の右片麻痺で救急搬送された．頭部MRIで，左中大脳動脈領域に拡散低下を認め，MRAで左内頸動脈はサイフォン部までしか描出されなかった．血小板数が低値で，血栓溶解療法の禁忌に該当したため，血栓回収療法を行った．血栓吸引を試みるも，有効再開通を得られなかった．その後，多臓器不全に至り死亡した．病理では，僧帽弁に血小板主体の白色血栓が付着し，非細菌性血栓性心内膜炎からの脳塞栓症と診断した．非細菌性血栓性心内膜炎による脳梗塞では，白色血栓であることが多く，硬いことが予想され，この点を考慮しデバイスを選択する必要がある． |
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| AbstractList | 症例は，73歳女性．十二指腸乳頭部癌の末期で外来通院中，突然の右片麻痺で救急搬送された．頭部MRIで，左中大脳動脈領域に拡散低下を認め，MRAで左内頸動脈はサイフォン部までしか描出されなかった．血小板数が低値で，血栓溶解療法の禁忌に該当したため，血栓回収療法を行った．血栓吸引を試みるも，有効再開通を得られなかった．その後，多臓器不全に至り死亡した．病理では，僧帽弁に血小板主体の白色血栓が付着し，非細菌性血栓性心内膜炎からの脳塞栓症と診断した．非細菌性血栓性心内膜炎による脳梗塞では，白色血栓であることが多く，硬いことが予想され，この点を考慮しデバイスを選択する必要がある． |
| Author | 村瀬, 永子 綾木, 孝 川端, 康弘 大谷, 良 安田, 謙 中村, 道三 |
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| References | 11) Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 2018;378:615-624. 3) Norisada K, Tanaka H, Onishi T, et al. Nonbacterial thrombotic endocarditis associated with cancer of unknown origin complicated with thrombus in the left auricular appendage: Case report. Cardiovasc Ultrasound 2011;9:8. 5) Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11-21. 1) Lopez JA RR, Fishbein MC, Siegel RJ. Nonbacterial thrombotic endocaiditis: A review. Am Heart J 1987;113:773-784. 9) Ikushima S, Ono R, Fukuda K, et al. Trousseau’s syndrome: Cancer-associated thrombosis. Jpn J Clin Oncol 2016;46:204-208. 7) Matsumoto N, Fukuda H, Handa A, et al. Histological examination of trousseau syndrome-related thrombus retrieved through acute endovascular thrombectomy: Report of 2 cases. J Stroke Cerebrovasc Dis 2016;25:e227-e230. 8) Shinohara T, Tsumura M, Hasegawa A, et al. A case of mechanical thrombectomy for middle cerebral artery occlusion with trousseau syndrome. Journal of Neuroendovascular Therapy 2017;11:485-491. 6) Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708-718. 2) Asopa S, Patel A, Khan OA, et al. Non-bacterial thrombotic endocarditis. Eur J Cardiothorac Surg 2007;32:696-701. 4) 日本脳卒中学会，日本脳神経外科学会，日本脳神経血管治療学会．経皮経管的脳血栓回収機器 適応使用指針 第3版．2018. p5-7. 10) Maekawa K, Shibata M, Nakajima H, et al. Erythrocyte-rich thrombus is associated with reduced number of maneuvers and procedure time in patients with acute ischemic stroke undergoing mechanical thrombectomy. Cerebrovascular Diseases Extra 2018;8:39-49. |
| References_xml | – reference: 1) Lopez JA RR, Fishbein MC, Siegel RJ. Nonbacterial thrombotic endocaiditis: A review. Am Heart J 1987;113:773-784. – reference: 4) 日本脳卒中学会，日本脳神経外科学会，日本脳神経血管治療学会．経皮経管的脳血栓回収機器 適応使用指針 第3版．2018. p5-7. – reference: 5) Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11-21. – reference: 7) Matsumoto N, Fukuda H, Handa A, et al. Histological examination of trousseau syndrome-related thrombus retrieved through acute endovascular thrombectomy: Report of 2 cases. J Stroke Cerebrovasc Dis 2016;25:e227-e230. – reference: 11) Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 2018;378:615-624. – reference: 3) Norisada K, Tanaka H, Onishi T, et al. Nonbacterial thrombotic endocarditis associated with cancer of unknown origin complicated with thrombus in the left auricular appendage: Case report. Cardiovasc Ultrasound 2011;9:8. – reference: 10) Maekawa K, Shibata M, Nakajima H, et al. Erythrocyte-rich thrombus is associated with reduced number of maneuvers and procedure time in patients with acute ischemic stroke undergoing mechanical thrombectomy. Cerebrovascular Diseases Extra 2018;8:39-49. – reference: 6) Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708-718. – reference: 9) Ikushima S, Ono R, Fukuda K, et al. Trousseau’s syndrome: Cancer-associated thrombosis. Jpn J Clin Oncol 2016;46:204-208. – reference: 2) Asopa S, Patel A, Khan OA, et al. Non-bacterial thrombotic endocarditis. Eur J Cardiothorac Surg 2007;32:696-701. – reference: 8) Shinohara T, Tsumura M, Hasegawa A, et al. A case of mechanical thrombectomy for middle cerebral artery occlusion with trousseau syndrome. Journal of Neuroendovascular Therapy 2017;11:485-491. |
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| Snippet | 症例は，73歳女性．十二指腸乳頭部癌の末期で外来通院中，突然の右片麻痺で救急搬送された．頭部MRIで，左中大脳動脈領域に拡散低下を認め，MRAで左内頸動脈はサイフォン... |
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| SubjectTerms | 白色血栓 脳梗塞 血栓回収療法 非細菌性血栓性心内膜炎 |
| Title | 非細菌性血栓性心内膜炎が原因の脳塞栓症に対し，血栓回収療法を試みた1剖検例 |
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