一過性脳虚血発作に対する頭蓋内外血管吻合術 : 対象となりうる症例と手術適応

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Extra-intracranial anastomosis has been attempted in patients with transient ischemic attacks (TIA) or reversible neurological deficits (RIND) in order to prevent subsequent strokes. This study was undertaken to seek appropriat5e candidates for this procedure from the clinical and angiographic points of view. Sixty-four cases with carotid TIA'(s) and/or RIND'(s) were investigated by angiography. Of the sixty-four cases, thirty-four had TIA'(s) only, twenty had RIND'(s) with history of TIA'(s) and ten had RIND'(s) only. Severe stenosis (more than 50%) and/or occlusion was found in eleven cases. One case had extracranial carotid occlusion, eight cases had intracranial internal carotid or middle cerebral artery stenosis and two cases had both intracranial and extracranial severe stenosis and/or occlusion, Seven patients out of these eleven cases had experienced frequent TIA's and RIND's. Three cases out of fifty-seven cases, excluding seven operated cases developed completed stroke (2 cerebral, infarction, 1 stroke) during the follow-up period from five months to three years (average, 19.2 months). Two patients developed cerebral infarction in the above mentioned seven cases, namely those cases that had experienced frequent TIA's and/or RIND's Consequently, if the patient has frequent TIA's and/or RIND's and has severe lesions in the intracranial or both intra-extracranial arteries, there us high possibility of subsequent cerebral infarction. Thus, these seven cases may be possible candidates for the extra-intracranial arterial anastomosis, which means seven cases out of our sixty-four cases (1l% ). Extra-intracranial arterial anastomosis was performed in two cases out of these seven cases, because etiology was considered to be cerebral vascular insufficiency confirmed by regional blood flow (rCBF) study or suspected by angiography which showed only one stenotic vertebral artery supplying blood to the brain. These two cases are to date free from symptoms following the operation, during follow-up period of five months and one year respectively. Our data suggest that extra-intracranial arterial anastomosis may be beneficial in a small group of patients with TIA's or RIND's. As more operated cases and non-operated cases are accumulated, more will be known both about the selection of patients and the value of this operation.
日本脳神経外科学会の論文

一過性脳虚血発作に対する頭蓋内外血管吻合術 : 対象となりうる症例と手術適応

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