頚動脈内膜剝離術の基本手技
頚動脈内膜剝離術（carotid endarterectomy：CEA）は，頚動脈狭窄に対してその効果が証明された手術法である．その一方で，内科的治療に対する優位性を保つために低い合併症率を担保できることが，術者に求められる要件となる．安全確実なCEAのためには，術前画像診断による手術のリスク評価をはじめとして，手術においては解剖学的知識をもとにした正確な剝離操作によるretromandibular spaceを広く開放しての必要十分な術野の確保・プラークを内包する動脈に対する愛護的操作・抗血小板剤継続での手術であるため確実な止血操作と動脈縫合が重要である．...
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| Published in | 脳卒中の外科 Vol. 50; no. 6; pp. 447 - 453 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2022
日本脳卒中の外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.50.447 |
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| Abstract | 頚動脈内膜剝離術（carotid endarterectomy：CEA）は，頚動脈狭窄に対してその効果が証明された手術法である．その一方で，内科的治療に対する優位性を保つために低い合併症率を担保できることが，術者に求められる要件となる．安全確実なCEAのためには，術前画像診断による手術のリスク評価をはじめとして，手術においては解剖学的知識をもとにした正確な剝離操作によるretromandibular spaceを広く開放しての必要十分な術野の確保・プラークを内包する動脈に対する愛護的操作・抗血小板剤継続での手術であるため確実な止血操作と動脈縫合が重要である． |
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| AbstractList | 頚動脈内膜剝離術（carotid endarterectomy：CEA）は，頚動脈狭窄に対してその効果が証明された手術法である．その一方で，内科的治療に対する優位性を保つために低い合併症率を担保できることが，術者に求められる要件となる．安全確実なCEAのためには，術前画像診断による手術のリスク評価をはじめとして，手術においては解剖学的知識をもとにした正確な剝離操作によるretromandibular spaceを広く開放しての必要十分な術野の確保・プラークを内包する動脈に対する愛護的操作・抗血小板剤継続での手術であるため確実な止血操作と動脈縫合が重要である． 「要旨」頚動脈内膜剥離術(carotid endarterectomy: CEA)は, 頚動脈狭窄に対してその効果が証明された手術法である. その一方で, 内科的治療に対する優位性を保つために低い合併症率を担保できることが, 術者に求められる要件となる. 安全確実なCEAのためには, 術前画像診断による手術のリスク評価をはじめとして, 手術においては解剖学的知識をもとにした正確な]R離操作によるretromandibular spaceを広く開放しての必要十分な術野の確保・プラークを内包する動脈に対する愛護的操作・抗血小板剤継続での手術であるため確実な止血操作と動脈縫合が重要である. |
| Author | 諸藤, 陽一 日宇, 健 松尾, 孝之 永田, 泉 高平, 良太郎 松永, 裕希 定方, 英作 案田, 岳夫 堀江, 信貴 山口, 将 出雲, 剛 |
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| DOI | 10.2335/scs.50.447 |
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| References | 18) Ichinose T, Naito K, Tsuruno T: Microsurgical interintimal dissection in carotid endarterectomy. World Neurosurg 82: e225-228, 2014 7) Crawford RS, Chung TK, Hodgman T, et al: Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg 46: 41-48, 2007 15) Hejčl A, Jiránková K, Malucelli A, et al: Selective internal carotid artery cross-clamping increases the specificity of cerebral oximetry for indication of shunting during carotid endarterectomy. Acta Neurochir（Wien）163:1807-1817, 2021 31) Uno M: Carotid endarterectomy. 脳外誌 21: 943-948, 2012 19) 出雲剛, 諸藤陽一, 藤本隆史, ほか：長崎大学における頚動脈内膜剥離術の基本手技. Neurosurg Emerg 22: 93-96, 2017 10) 遠藤俊郎，平島豊，桑山直也，ほか：頸動脈内膜剥離術の基本手技．脳外誌 8: 92-99, 1999 13) Harrison GJ, How TV, Poole RJ, et al: Closure technique after carotid endarterectomy influences local hemodynamics. J Vasc Surg 60: 418-427, 2014 27) 佐藤成登志，小林量作，地神裕史，ほか：加齢による脊柱可動域の検討．第48回日本理学療法学術大会抄録集，2013 DOI:https://doi.org/10.14900/cjpt.12012.0.48101379.0 11) Goodney PP, Nolan BW, Eldrup-Jorgensen J, et al: Restenosis after carotid endarterectomy in a multicenter regional registry. J Vasc Surg 52: 897-904, 905.e1-2, 2010 33) Wiske C, Arhuidese I, Malas M, et al: Comparing the efficacy of shunting approaches and cerebral monitoring during carotid endarterectomy using a national database. J Vasc Surg 68: 416-425, 2018 24) Moore WS, Popma JJ, Roubin GS, et al: Carotid angiographic characteristics in the CREST trial were major contributors to periprocedural stroke and death differences between carotid artery stenting and carotid endarterectomy. J Vasc Surg 63: 851-857, 858.e1, 2016 22) Kakisis JD, Antonopoulos CN, Moulakakis KG, et al: Protamine reduces bleeding complications without increasing the risk of stroke after carotid endarterectomy: a meta-analysis. Eur J Vasc Endovasc Surg 52: 296-307, 2016 5) Chida K, Shimada Y, Fujimoto K, et al: Identification of the distal end of carotid plaque using 3-dimensional fast spin echo T1-weighted magnetic resonance plaque imaging. J Stroke Cerebrovasc Dis 29: 104680, 2020 25) 鳴海治，吉田和道，沈正樹，ほか：高位内頚動脈狭窄病変に対する頚動脈内膜剝離術における解剖に基づいた手術手技の工夫─Styloid Diaphragmの解剖を中心に．脳卒中の外科 38: 380-386, 2010 26) 日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン 2015．東京，協和企画，2015，pp127-130 6) Chongruksut W, Vaniyapong T, Rerkasem K: Routine or selective carotid artery shunting for carotid endarterectomy （and different methods of monitoring in selective shunting）. Cochrane Database Syst Rev 2014: CD000190, 2014 9) Domenick Sridharan N, Thirumala P, Chaer R, et al: Predictors of cross-clamp-induced intraoperative monitoring changes during carotid endarterectomy using both electroencephalography and somatosensory evoked potentials. J Vasc Surg 67: 191-198, 2018 30) 豊田章宏，島健，西田正博，ほか：頸部頸動脈分岐部の放射線学的検討─邦人とハンガリー人の比較．脳と神経 49:633-637, 1997 1) Aburahma AF, Mousa AY, Stone PA: Shunting during carotid endarterectomy. J Vasc Surg 54: 1502-1510, 2011 21) 今田裕尊，川本仁志，三原千惠，ほか：頚部軟部組織の層構造に基づいた高位CEAにおける耳下腺周囲の剝離．脳卒中の外科 48: 292-299, 2020 23) Kondov S, Beyersdorf F, Schöllhorn J, et al: Outcome of nearinfrared spectroscopy-guided selective shunting during carotid endarterectomy in general anesthesia. Ann Vasc Surg 61: 170-177, 2019 28) The Committee for Japan Neurosurgery Registry: Report of Japan Neurosurgery Report（2015-2017）. 11. Therapeutic trends in diseases with multiple options 11.6 Cervical Carotid stenosis. Neurol Med Chir（Tokyo）59（Supecial Issue）: 80, 2019 4) Brott TG, Halperin JL, Abbara S, et al: 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. J Am Coll Cardiol 57: 1002-1044, 2011 20) Izumo T, Ujifuku K, Baba S, et al: Initial experience of ORBEYETM surgical microscope for carotid endarterectomy. Asian J Neurosurg 14: 839-842, 2019 17) Huizing E, Vos CG, van den Akker PJ, et al: A systematic review of patch angioplasty versus primary closure for carotid endarterectomy. J Vasc Surg 69: 1962-1974.e4, 2019 29) Tamaki T, Morita A: Neck haematoma after carotid endarterectomy: risks, rescue, and prevention. Br J Neurosurg 33: 156-160, 2019 16) Hertzer NR, O’Hara PJ, Mascha EJ, et al: Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg 26: 1-10, 1997 32) Uno M, Takai H, Yagi K, et al: Surgical technique for carotid endarterectomy: current methods and problems. Neurol Med Chir（Tokyo）60: 419-428, 2020 8) Dakour-Aridi H, Ou M, Locham S, et al: Outcomes following eversion versus conventional endarterectomy in the vascular quality initiative database. Ann Vasc Surg 65: 1-9, 2020 3) Bandyk DF, Kaebnick HW, Adams MB, et al: Turbulence occurring after carotid bifurcation endarterectomy: a harbinger of residual and recurrent carotid stenosis. J Vasc Surg 7: 261-274, 1988 2) AbuRahma AF, Robinson PA, Saiedy S, et al: Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: long-term follow-up. J Vasc Surg 27: 222-232, 1998 12) Gray H: Gray’s Anatomy（36th ed）. Churchill Livingstone, Edinburgh, London, Melbourne, New York, 1980, pp676-692 14) Hayashi N, Hori E, Ohtani Y, et al: Surgical anatomy of the cervical carotid artery for carotid endarterectomy. Neurol Med Chir（Tokyo）45: 25-29; discussion 30, 2005 |
| References_xml | – reference: 23) Kondov S, Beyersdorf F, Schöllhorn J, et al: Outcome of nearinfrared spectroscopy-guided selective shunting during carotid endarterectomy in general anesthesia. Ann Vasc Surg 61: 170-177, 2019 – reference: 32) Uno M, Takai H, Yagi K, et al: Surgical technique for carotid endarterectomy: current methods and problems. Neurol Med Chir（Tokyo）60: 419-428, 2020 – reference: 2) AbuRahma AF, Robinson PA, Saiedy S, et al: Prospective randomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: long-term follow-up. J Vasc Surg 27: 222-232, 1998 – reference: 1) Aburahma AF, Mousa AY, Stone PA: Shunting during carotid endarterectomy. J Vasc Surg 54: 1502-1510, 2011 – reference: 9) Domenick Sridharan N, Thirumala P, Chaer R, et al: Predictors of cross-clamp-induced intraoperative monitoring changes during carotid endarterectomy using both electroencephalography and somatosensory evoked potentials. J Vasc Surg 67: 191-198, 2018 – reference: 12) Gray H: Gray’s Anatomy（36th ed）. Churchill Livingstone, Edinburgh, London, Melbourne, New York, 1980, pp676-692 – reference: 17) Huizing E, Vos CG, van den Akker PJ, et al: A systematic review of patch angioplasty versus primary closure for carotid endarterectomy. J Vasc Surg 69: 1962-1974.e4, 2019 – reference: 19) 出雲剛, 諸藤陽一, 藤本隆史, ほか：長崎大学における頚動脈内膜剥離術の基本手技. Neurosurg Emerg 22: 93-96, 2017 – reference: 26) 日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン 2015．東京，協和企画，2015，pp127-130 – reference: 16) Hertzer NR, O’Hara PJ, Mascha EJ, et al: Early outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995. J Vasc Surg 26: 1-10, 1997 – reference: 22) Kakisis JD, Antonopoulos CN, Moulakakis KG, et al: Protamine reduces bleeding complications without increasing the risk of stroke after carotid endarterectomy: a meta-analysis. Eur J Vasc Endovasc Surg 52: 296-307, 2016 – reference: 5) Chida K, Shimada Y, Fujimoto K, et al: Identification of the distal end of carotid plaque using 3-dimensional fast spin echo T1-weighted magnetic resonance plaque imaging. J Stroke Cerebrovasc Dis 29: 104680, 2020 – reference: 14) Hayashi N, Hori E, Ohtani Y, et al: Surgical anatomy of the cervical carotid artery for carotid endarterectomy. Neurol Med Chir（Tokyo）45: 25-29; discussion 30, 2005 – reference: 28) The Committee for Japan Neurosurgery Registry: Report of Japan Neurosurgery Report（2015-2017）. 11. Therapeutic trends in diseases with multiple options 11.6 Cervical Carotid stenosis. Neurol Med Chir（Tokyo）59（Supecial Issue）: 80, 2019 – reference: 10) 遠藤俊郎，平島豊，桑山直也，ほか：頸動脈内膜剥離術の基本手技．脳外誌 8: 92-99, 1999 – reference: 15) Hejčl A, Jiránková K, Malucelli A, et al: Selective internal carotid artery cross-clamping increases the specificity of cerebral oximetry for indication of shunting during carotid endarterectomy. Acta Neurochir（Wien）163:1807-1817, 2021 – reference: 24) Moore WS, Popma JJ, Roubin GS, et al: Carotid angiographic characteristics in the CREST trial were major contributors to periprocedural stroke and death differences between carotid artery stenting and carotid endarterectomy. J Vasc Surg 63: 851-857, 858.e1, 2016 – reference: 13) Harrison GJ, How TV, Poole RJ, et al: Closure technique after carotid endarterectomy influences local hemodynamics. J Vasc Surg 60: 418-427, 2014 – reference: 20) Izumo T, Ujifuku K, Baba S, et al: Initial experience of ORBEYETM surgical microscope for carotid endarterectomy. Asian J Neurosurg 14: 839-842, 2019 – reference: 21) 今田裕尊，川本仁志，三原千惠，ほか：頚部軟部組織の層構造に基づいた高位CEAにおける耳下腺周囲の剝離．脳卒中の外科 48: 292-299, 2020 – reference: 30) 豊田章宏，島健，西田正博，ほか：頸部頸動脈分岐部の放射線学的検討─邦人とハンガリー人の比較．脳と神経 49:633-637, 1997 – reference: 31) Uno M: Carotid endarterectomy. 脳外誌 21: 943-948, 2012 – reference: 7) Crawford RS, Chung TK, Hodgman T, et al: Restenosis after eversion vs patch closure carotid endarterectomy. J Vasc Surg 46: 41-48, 2007 – reference: 33) Wiske C, Arhuidese I, Malas M, et al: Comparing the efficacy of shunting approaches and cerebral monitoring during carotid endarterectomy using a national database. J Vasc Surg 68: 416-425, 2018 – reference: 29) Tamaki T, Morita A: Neck haematoma after carotid endarterectomy: risks, rescue, and prevention. Br J Neurosurg 33: 156-160, 2019 – reference: 18) Ichinose T, Naito K, Tsuruno T: Microsurgical interintimal dissection in carotid endarterectomy. World Neurosurg 82: e225-228, 2014 – reference: 4) Brott TG, Halperin JL, Abbara S, et al: 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. J Am Coll Cardiol 57: 1002-1044, 2011 – reference: 27) 佐藤成登志，小林量作，地神裕史，ほか：加齢による脊柱可動域の検討．第48回日本理学療法学術大会抄録集，2013 DOI:https://doi.org/10.14900/cjpt.12012.0.48101379.0 – reference: 11) Goodney PP, Nolan BW, Eldrup-Jorgensen J, et al: Restenosis after carotid endarterectomy in a multicenter regional registry. J Vasc Surg 52: 897-904, 905.e1-2, 2010 – reference: 25) 鳴海治，吉田和道，沈正樹，ほか：高位内頚動脈狭窄病変に対する頚動脈内膜剝離術における解剖に基づいた手術手技の工夫─Styloid Diaphragmの解剖を中心に．脳卒中の外科 38: 380-386, 2010 – reference: 8) Dakour-Aridi H, Ou M, Locham S, et al: Outcomes following eversion versus conventional endarterectomy in the vascular quality initiative database. Ann Vasc Surg 65: 1-9, 2020 – reference: 3) Bandyk DF, Kaebnick HW, Adams MB, et al: Turbulence occurring after carotid bifurcation endarterectomy: a harbinger of residual and recurrent carotid stenosis. J Vasc Surg 7: 261-274, 1988 – reference: 6) Chongruksut W, Vaniyapong T, Rerkasem K: Routine or selective carotid artery shunting for carotid endarterectomy （and different methods of monitoring in selective shunting）. Cochrane Database Syst Rev 2014: CD000190, 2014 |
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| Snippet | 頚動脈内膜剝離術（carotid endarterectomy：CEA）は，頚動脈狭窄に対してその効果が証明された手術法である．その一方で，内科的治療に対する優位性を保つために低い合併... 「要旨」頚動脈内膜剥離術(carotid endarterectomy: CEA)は, 頚動脈狭窄に対してその効果が証明された手術法である. その一方で, 内科的治療に対する優位性を保つために低い... |
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| Title | 頚動脈内膜剝離術の基本手技 |
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| ispartofPNX | 脳卒中の外科, 2022, Vol.50(6), pp.447-453 |
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