無症候性頸動脈狭窄症に対する血栓内膜剥離術(CEA)の治療成績(<特集>無症候性頸動脈狭窄症に対する外科治療)

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We analyzed surgical results of carotid endarterectomy (CEA) for asymptomatic carotid stenosis to clarify factors related to stroke mortality and morbidity. In the past 13 years (1986-1998), CEA was performed in 91 patients with symptomatic carotid stenosis and 54 patients with 56 asymptomatic carotid stenosis. Surgical indication was confirmed by angiographic high-grade stenosis (>70%) estimated using the NASCET criterion in both groups. CEA was performed under general anesthesia (normotention and normocapnia), and internal shunting was carried out under general heparinization. Cerebral ischemic events during operation was monitored by SEP and intraoperative DSA. To determine recent results of CEA, we investigated the ratio of CEA for symptomatic and asymptomatic group, and perioperative mortality and morbidity in both groups. Since 1995, resting and acetazolamide-activated CBF, and severity of hemodynamic cerebral ischemia (Stage O-II) was quantified using ^<123>I-IMP ARG method and preoperative cerebral hemodynamics was compared in both symptomatic patients (n=30) and asymptomatic patients (n=24). Additionally, we estimated which surgical procedure related to stroke morbidity. The ratio of CEA for symptomatic lesion and asymptomatic lesion was 91 lesions (62%) vs. 56 lesions (38%) in 1986-1998, 33 lesions (55%) vs. 27 lesions (45%) in 1995-1998 and 13 lesions (45%) vs. 17 lesions (55%) in 1998, respectively. The number of CEAs for asymptomatic lesions has increased in recent years. Overall surgical morbidity and mortality was 5 cases (3.4%) and 0% in 147 lesions, and morbidity was 4 cases (4.4%) in 91 symptomatic lesions, and 1 case (1.8%) in 56 asymptomatic lesions. A significant difference in resting CBF was observed between symptomatic patients (31.8+6.1 ml/100 g/min) and asymptomatic patients (37.6+6.6 ml/100 g/min) (P< 0.002, t-test). The severity of hemodynamic cerebral ischemia based on resting and acetazolamide-activated CBF did not differ significantly between groups (X^2-test). However, Stage II ischemia (hemodynamically compromised state) was 20% in symptomatic patients and 8% in asymptomatic patients. Hemodynamic cerebral ischemia was generally mild in asymptomatic patients.
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血栓内膜剥離術(CEA)の治療成績(<特集>無症候性頸動脈狭窄症に対する外科治療)

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