頸部内頸動脈閉塞性病変に対する急性期血行再建術 : その適応と限界について

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Revascularization treatment for occlusion of the intracranial artery is effective, but the outcome is still poor or sometimes death in patients with occlusion of the cervical internal carotid artery. We investigated the indications and limitations of percutaneous revascularization for cervical internal carotid artery occlusion. Five patients with atherosclerotic occlusion (thrombosis) and 7 patients with embolic occlusion (embolism) were admitted within a few hours of onset and treated with local thrombolysis and percutaneous transluminal angioplasty (PTA). Angiographical examination was performed before treatment using a bolus of contrast material injected just distal to the occlusion via a microcatheter passed through the area. All cases of thrombosis were successfully revascularized, but 1 patient suffered reocclusion by the next day. Carotid endarterectomy (CEA) and stenting were performed in 1 case each. Two cases of embolism remained stationary, and 5 cases of embolism were complicated by migration to the distal internal carotid artery or middle cerebral artery. The outcome was good recovery in 3 patients with thrombosis and no deaths, whereas all patients with embolism had moderate disability or worse, and 3 died. Emergency percutaneous revascularization is indicated for the treatment of thrombosis. Recanalization is potentially effective when performed with the combination of thrombolysis and PTA. Postoperative care is required to prevent subsequent reocclusion, and CEA or stenting can be performed later. In contrast, percutaneous revascularization may not be indicated for the treatment of embolic occlusion, because of the risk of collateral circulation damage.
日本脳卒中の外科学会の論文
2002-05-31

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