無症候性頸動脈狭窄症に対する頸動脈内膜剥離術(<特集>無症候性頸動脈狭窄症に対する外科治療)

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Since the results of ACAS were first reported, carotid endarterectomy (CEA) in patients with asymptomatic carotid stenosis has been increasing in Japan. In this report, we evaluate our results of CEA in patients with asymptomatic carotid stenosis and complications, and discuss the indication of CEA in Japanese patients with asymptomatic carotid stenosis. From January 1975 to December 1998, 318 CEAs were performed. Of these, 116 CEAs in 107 patients were carried out for asymptomatic carotid stenosis. Overall mortality was 4/116 (3.4%). There was 1 permanent morbidity (0.9%). Therefore, the mortality and morbidity rate was 4.3%. Twenty-one patients (19.6%) were over 70 years old (range 70-75 years old) and mortality and morbidity in these patients was 0%. Ultrasonography was applied to 54 patients prior to CEA, showing ulcer in 50% of them. Intraplaque hemorrhage was found in 7 of 15 with hypoechoic plaque. Coronary angiography was performed in 54 patients. The patients with a history of ischemic heart disease (IHD) showed more severe coronary stenosis than patients without any history of IHD. However, 60.5% of the patients without any history of IHD showed some degree of coronary stenosis. No patient who underwent coronary angiography suffered IHD during CEA and postoperative course. Based on these results, we conclude that the indications of CEA for asymptomatic patients are as follows: 1) ICA stenosis of more than 70%, 2) patients under 75 years old who can be expected to live more than 5 years, 3) patients with plaque showing hypoechoic and ulcer by Ultrasonography and 4) patients who have undergone coronary examination or treatment for IHD and can tolerate general anesthesia.
日本脳卒中の外科学会の論文
2000-05-31

無症候性頸動脈狭窄症に対する頸動脈内膜剥離術(<特集>無症候性頸動脈狭窄症に対する外科治療)

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