無症候性頸動脈狭窄に対する内膜剥離術(CEA) : CEAの妥当性について

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Reduction of complications of carotid endarterectomy (CEA) for carotid artery stenosis is essential for keeping the superiority of CEA over the medical treatment. Therefore, we must recognize the specific features of the asymptomatic carotid artery stenosis (AS-ICAS) to avoid operative complications. Of 290 CEAs performed on patients with carotid artery stenosis, 109 CEAs were done for the AS-ICAS. Our indications of CEA for AS-ICAS were stenosis over 60%, hypoechoic or heterogeneous echogenesity and ulceration detected by B-mode ultrasonography and progression of the stenosis. We routinely use the T-shaped shunt tube and intraoperative monitoring such as somatosensory evoked potential (SEP). To obtain specific features of AS-ICAS, we analyzed cerebral blood flow, intraoperative monitoring and frequencies of associated systemic diseases in the patients with AS-ICAS. Perioperative mortality and morbidity of CEA for the patients with AS-ICAS were 0 and 1.8%, respectively. Cerebral blood flow of the territory of the middle cerebral artery (rCBF) and cerebrovascular reactivity (rCVR) were not lower than those on the contralateral side. Compared with those of symptomatic carotid artery stenosis (S-ICAS), there was no significant difference in rCBF or rCVR, although rCVR of S-ICAS was relatively lower than that of AS-ICAS. There was no significant difference in the intraoperative monitoring between AS-ICAS and S-ICAS. Hyperperfusion after CEA of AS-ICAS occurred in 2.0% which was not significantly lower than the 6.5% of S-ICAS. Specific features of CEA for AS-ICAS were not obtained from this study. According to the mortality and morbidity of our CEAs, CEA for AS-ICAS was acceptable.
日本脳卒中の外科学会の論文
2007-05-31

無症候性頸動脈狭窄に対する内膜剥離術(CEA) : CEAの妥当性について

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