対側に高度閉塞性病変を伴った頸動脈高度狭窄例の脳循環動態の特徴と治療

内頸動脈狭窄に対する内頸動脈内膜剥離術(CEA)は欧米のcooperative study10)25)で内科治療群より優れていたことから, 本邦でも広く行われるようになってきており, 病態に対する理解度も深くなってきている. しかし, 対側の内頸動脈にも高度の狭窄, あるいは閉塞を伴った両側性の高度閉塞性病変を持つ症例における脳循環動態は, 遭遇する症例が少ないため, まだ不明な点が多い. したがって両側病変に対して循環動態を考慮した治療法の確立はできていないのが現状と考えられる. 本邦でもCEA件数は増加しているため, 今後両側性の高度閉塞性病変を持つ症例に遭遇する機会は増えてくると考えられ...

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Published in脳卒中の外科 Vol. 30; no. 5; pp. 380 - 386
Main Authors 山根, 冠児, 石野, 真輔, 畠山, 尚志, 三原, 千恵, 豊田, 章宏, 平松, 和嗣久, 西田, 正博, 島, 健
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本脳卒中の外科学会 2002
日本脳卒中の外科学会
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ISSN0914-5508
1880-4683
DOI10.2335/scs.30.380

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Abstract 内頸動脈狭窄に対する内頸動脈内膜剥離術(CEA)は欧米のcooperative study10)25)で内科治療群より優れていたことから, 本邦でも広く行われるようになってきており, 病態に対する理解度も深くなってきている. しかし, 対側の内頸動脈にも高度の狭窄, あるいは閉塞を伴った両側性の高度閉塞性病変を持つ症例における脳循環動態は, 遭遇する症例が少ないため, まだ不明な点が多い. したがって両側病変に対して循環動態を考慮した治療法の確立はできていないのが現状と考えられる. 本邦でもCEA件数は増加しているため, 今後両側性の高度閉塞性病変を持つ症例に遭遇する機会は増えてくると考えられる. したがって, 両側に高度の閉塞性病変を持つ症例の循環動態の特徴を調べ, その特徴をふまえた適切な治療指針を確立することは意義あることと考えられる. 症例 対象とした症例は, 血行再建術を行った症例で, 内頸動脈に70%以上の高度狭窄を両側性に認めた8例(Bil-ICAS), 一側内頸動脈の高度狭窄と反対側内頸動脈の閉塞を認めた5例(ICAS+ICAO)で, 計13例で検討した(Table1).
AbstractList 内頸動脈狭窄に対する内頸動脈内膜剥離術(CEA)は欧米のcooperative study10)25)で内科治療群より優れていたことから, 本邦でも広く行われるようになってきており, 病態に対する理解度も深くなってきている. しかし, 対側の内頸動脈にも高度の狭窄, あるいは閉塞を伴った両側性の高度閉塞性病変を持つ症例における脳循環動態は, 遭遇する症例が少ないため, まだ不明な点が多い. したがって両側病変に対して循環動態を考慮した治療法の確立はできていないのが現状と考えられる. 本邦でもCEA件数は増加しているため, 今後両側性の高度閉塞性病変を持つ症例に遭遇する機会は増えてくると考えられる. したがって, 両側に高度の閉塞性病変を持つ症例の循環動態の特徴を調べ, その特徴をふまえた適切な治療指針を確立することは意義あることと考えられる. 症例 対象とした症例は, 血行再建術を行った症例で, 内頸動脈に70%以上の高度狭窄を両側性に認めた8例(Bil-ICAS), 一側内頸動脈の高度狭窄と反対側内頸動脈の閉塞を認めた5例(ICAS+ICAO)で, 計13例で検討した(Table1).
Author 石野, 真輔
西田, 正博
平松, 和嗣久
三原, 千恵
山根, 冠児
島, 健
豊田, 章宏
畠山, 尚志
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References 12) Gasecki A, Eliasziw M, Ferguson GG, et al: Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg 83: 778-782, 1995
7) Darling RCIII, Kubaska S, Shah DM, et al: Bilateral carotid endarterectomy during the same hospital admission. Cardiovasc Surgery 4: 759-762, 1996
15) Ille O, Woimant F, Pruna A, et al: Hypertensive encephalopathy after bilateral carotid endarterectomy. Stroke 26: 488-491, 1995
19) Liapis CD, Satiani B, Florance CL, et al: Motor speech malfunction following carotid endarterectomy. Surgery 89: 56-59, 1981
20) Markus HS, Harrison MJ, Adiseshiah M: Carotid endarterectomy improves hemodynamics on the contralateral side: implications for operating contralateral to an occluded carotid artery. Br J Surg 80: 170-172, 1993
11) Fields WS, Lemak NA: Joint study of extracranial arterial occlusion X. Internal carotid occlusion. JAMA 235: 26-31, 1976
23) Morrow CE, Espada R, Howell JF: Operative and long-term results of staged contralateral carotid endarterectomy: a personal series. Surgery 103: 242-246, 1988
26) Verta MJ Jr, Applebaum EL, McClusky DA, et al: Cranial nerve injury during carotid endarterectomy. Ann Surg 185: 192-195, 1977
13) Hammacher ER, Eikelboom BC, Bast TJ, et al: Surgical treatment of patients with a carotid artery occlusion and a contralateral stenosis. J Cardiovasc Surg 22: 513-517, 1984
5) Cao P, Giordano G, De Rango P, et al: Carotid endarterectomy contralateral to an occluded carotid artery: a retrospective case-control study. Eur J Vasc Endovasc Surg 10: 16-22, 1995
28) Widder B, Kleiser B, Krapf H: Course of cerebrovascular reactivity in patients with carotid artery occlusion. Stroke 27: 1970-1973, 1994
3) Baker WH, Littooy FN, Hayes AC, et al: Carotid endarterectomy without a shunt: the control series. J Vasc Surg 1: 50-56, 1984
10) Executive Committee for the Asymptomatic Carotid Atherosclerosis Study: Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273: 1421-1428, 1995
8) Deriu GP, Franceschi L, Milite D, et al: Carotid artery endarterectomy in patients with contralateral carotid artery occlusion: perioperative hazards and late results. Ann Vasc Surg 8: 307-342, 1994
16) Kagawa R, Moritake K, Shima T, et al: Validity of B-mode ultrasonographic findings in patients undergoing carotid endarterectomy in comparison with angiographic and clinicopathologic features. Stroke 27: 700-705, 1996
31) Yamane K, Shima T, Nishida M, et al: Changes in cerebral blood flow after carotid endarterectomy. Keio J Med 49 (suppl): A80-82, 2000
22) Meyer FB, Fode NC, Marsh WR, et al: Carotid endarterectomy in patients with contralateral occlusion. Mayo Clin Proc 68: 307-342, 1993
25) North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325: 445-453, 1991
14) Higashi S, Matsuda H, Fujii H, et al: Luxury perfusion syndrome confirmed by sequential studies of regional cerebral blood flow and volume after extracranial to intracranial bypass surgery: case report. Neurosurgery 22: 85-89, 1989
9) Estes JM, Khabbaz KR, Barnatan M, et al: Outcome after combined carotid endarterectomy and coronary artery bypass is related patient selection. J Vasc Surg 30: 1179-1184, 2001
18) Lesage R, Paris E, Koskas F, et al: Surgical reconstruction of the internal carotid artery with contralateral occlusion without use of shunt. Ann Vasc Surg 5: 55-60, 1991
2) Aungst M, Gahtan V, Berkowitz H, et al: Carotid endarterectomy outcome is not affected in patients with a contralateral carotid occlusion. Am J Surg 166: 30-30, 1998
1) Archie JP, Feldtman RW: Critical stenosis of the internal carotid artery. Surgery 89: 66-62, 1981
30) 山根冠児, 島, 健, 岡田芳和, そのほか : 頸部内頸動脈狭窄の脳循環動態と対策. 脳卒中 20: 400-407, 1998
29) 山根冠児, 島, 健, 岡田芳和, そのほか : 内頸動脈狭窄症に対する血栓内膜摘除術の術中モニタリング―安全な手術のために―. 脳外誌 7: 554-562, 1998
4) Ballotta E, Da Giau G, Guerra M: Carotid endarterectomy and contralateral internal carotid artery occlusion: perioperative risks and long-term stroke and survival rates. Surgery 123: 234-240, 1998
27) Wade MG, Larson PC, Hickey RH, et al: Effect of carotid endarterectomy on carotid chemoreceptor and baroreceptor function. Surg Forum 19: 144-145, 1968
24) Nicholls SC, Kohler TR, Bergelin RO, et al: Carotid artery occlusion: natural history. J Vasc Surg 4: 479-485, 1986
6) Coyle KA, Smith RB, Salam AA, et al: Carotid endarterectomy in patients with contralateral carotid occlusion; review of a 10-year experience. Cardiovas Surg 4: 71-75, 1996
21) Matteis M, Vernieri F, Caltagirone C, et al: Patterns of cerebrovascular reactivity in patients with carotid artery occlusion and severe contralateral stenosis. J Neurol Sci 168: 47-51, 1999
17) Lacroix H, Beets G, von Hemelrijck J, et al: Carotid artery surgery in the presence of an occlusion of the contralateral carotid artery: perioperative risk analysis and follow-up. Cardiovasc Surg 2: 26-31, 1994
References_xml – reference: 7) Darling RCIII, Kubaska S, Shah DM, et al: Bilateral carotid endarterectomy during the same hospital admission. Cardiovasc Surgery 4: 759-762, 1996
– reference: 26) Verta MJ Jr, Applebaum EL, McClusky DA, et al: Cranial nerve injury during carotid endarterectomy. Ann Surg 185: 192-195, 1977
– reference: 18) Lesage R, Paris E, Koskas F, et al: Surgical reconstruction of the internal carotid artery with contralateral occlusion without use of shunt. Ann Vasc Surg 5: 55-60, 1991
– reference: 27) Wade MG, Larson PC, Hickey RH, et al: Effect of carotid endarterectomy on carotid chemoreceptor and baroreceptor function. Surg Forum 19: 144-145, 1968
– reference: 19) Liapis CD, Satiani B, Florance CL, et al: Motor speech malfunction following carotid endarterectomy. Surgery 89: 56-59, 1981
– reference: 15) Ille O, Woimant F, Pruna A, et al: Hypertensive encephalopathy after bilateral carotid endarterectomy. Stroke 26: 488-491, 1995
– reference: 25) North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325: 445-453, 1991
– reference: 2) Aungst M, Gahtan V, Berkowitz H, et al: Carotid endarterectomy outcome is not affected in patients with a contralateral carotid occlusion. Am J Surg 166: 30-30, 1998
– reference: 12) Gasecki A, Eliasziw M, Ferguson GG, et al: Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg 83: 778-782, 1995
– reference: 30) 山根冠児, 島, 健, 岡田芳和, そのほか : 頸部内頸動脈狭窄の脳循環動態と対策. 脳卒中 20: 400-407, 1998
– reference: 24) Nicholls SC, Kohler TR, Bergelin RO, et al: Carotid artery occlusion: natural history. J Vasc Surg 4: 479-485, 1986
– reference: 4) Ballotta E, Da Giau G, Guerra M: Carotid endarterectomy and contralateral internal carotid artery occlusion: perioperative risks and long-term stroke and survival rates. Surgery 123: 234-240, 1998
– reference: 13) Hammacher ER, Eikelboom BC, Bast TJ, et al: Surgical treatment of patients with a carotid artery occlusion and a contralateral stenosis. J Cardiovasc Surg 22: 513-517, 1984
– reference: 3) Baker WH, Littooy FN, Hayes AC, et al: Carotid endarterectomy without a shunt: the control series. J Vasc Surg 1: 50-56, 1984
– reference: 8) Deriu GP, Franceschi L, Milite D, et al: Carotid artery endarterectomy in patients with contralateral carotid artery occlusion: perioperative hazards and late results. Ann Vasc Surg 8: 307-342, 1994
– reference: 29) 山根冠児, 島, 健, 岡田芳和, そのほか : 内頸動脈狭窄症に対する血栓内膜摘除術の術中モニタリング―安全な手術のために―. 脳外誌 7: 554-562, 1998
– reference: 23) Morrow CE, Espada R, Howell JF: Operative and long-term results of staged contralateral carotid endarterectomy: a personal series. Surgery 103: 242-246, 1988
– reference: 31) Yamane K, Shima T, Nishida M, et al: Changes in cerebral blood flow after carotid endarterectomy. Keio J Med 49 (suppl): A80-82, 2000
– reference: 6) Coyle KA, Smith RB, Salam AA, et al: Carotid endarterectomy in patients with contralateral carotid occlusion; review of a 10-year experience. Cardiovas Surg 4: 71-75, 1996
– reference: 21) Matteis M, Vernieri F, Caltagirone C, et al: Patterns of cerebrovascular reactivity in patients with carotid artery occlusion and severe contralateral stenosis. J Neurol Sci 168: 47-51, 1999
– reference: 28) Widder B, Kleiser B, Krapf H: Course of cerebrovascular reactivity in patients with carotid artery occlusion. Stroke 27: 1970-1973, 1994
– reference: 11) Fields WS, Lemak NA: Joint study of extracranial arterial occlusion X. Internal carotid occlusion. JAMA 235: 26-31, 1976
– reference: 16) Kagawa R, Moritake K, Shima T, et al: Validity of B-mode ultrasonographic findings in patients undergoing carotid endarterectomy in comparison with angiographic and clinicopathologic features. Stroke 27: 700-705, 1996
– reference: 17) Lacroix H, Beets G, von Hemelrijck J, et al: Carotid artery surgery in the presence of an occlusion of the contralateral carotid artery: perioperative risk analysis and follow-up. Cardiovasc Surg 2: 26-31, 1994
– reference: 22) Meyer FB, Fode NC, Marsh WR, et al: Carotid endarterectomy in patients with contralateral occlusion. Mayo Clin Proc 68: 307-342, 1993
– reference: 10) Executive Committee for the Asymptomatic Carotid Atherosclerosis Study: Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273: 1421-1428, 1995
– reference: 1) Archie JP, Feldtman RW: Critical stenosis of the internal carotid artery. Surgery 89: 66-62, 1981
– reference: 9) Estes JM, Khabbaz KR, Barnatan M, et al: Outcome after combined carotid endarterectomy and coronary artery bypass is related patient selection. J Vasc Surg 30: 1179-1184, 2001
– reference: 5) Cao P, Giordano G, De Rango P, et al: Carotid endarterectomy contralateral to an occluded carotid artery: a retrospective case-control study. Eur J Vasc Endovasc Surg 10: 16-22, 1995
– reference: 14) Higashi S, Matsuda H, Fujii H, et al: Luxury perfusion syndrome confirmed by sequential studies of regional cerebral blood flow and volume after extracranial to intracranial bypass surgery: case report. Neurosurgery 22: 85-89, 1989
– reference: 20) Markus HS, Harrison MJ, Adiseshiah M: Carotid endarterectomy improves hemodynamics on the contralateral side: implications for operating contralateral to an occluded carotid artery. Br J Surg 80: 170-172, 1993
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Snippet 内頸動脈狭窄に対する内頸動脈内膜剥離術(CEA)は欧米のcooperative study10)25)で内科治療群より優れていたことから, 本邦でも広く行われるようになってきており, 病態に...
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Title 対側に高度閉塞性病変を伴った頸動脈高度狭窄例の脳循環動態の特徴と治療
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