頭蓋外・内頸動脈狭窄性病変に対する外科的療法の臨床:-自験34例について-
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概要
- 論文の詳細を見る
Thirty four cases of the occlusive cerebrovascular diseases which were attributed to the extracranial carotid lesions, were managed surgically for last three and a half years. Unilateral carotid endarterectomy (CEA) were carried out in 16 cases, bilateral CEA in one, STA-MCA anastomosis (bypass) in 9, both of CEA and bypass in 5 and segmental carotid resection and reconstruction of the kinked carotid artery in 3.<BR>Investigation of the aging factors to angiographical changes of the extracranial internal carotid arteries was carried out statistically with 403 cases of carotid angiograms, which were included 112 cases of cerebrovascular accident group and 391 cases of the control group. Grades of stenotic lesions, including the ulceration or irregularity of the vessel wall, were found rather higher rate in CVA group to the control group.<BR>It has been considered that there were two principal theories of the cause of cerebral ischemia, namely, reduced cerebral blood flow caused by arterial stenosis and intermittent embolization from ulcerated atheromas of the carotid artery. Four vessel angiography usually performed in various angles with subtruction or high magnification method for the confirmation of these hypothesis.<BR>Complications were found in 4 cases of 22 patients undergoing CEA. Temporary neurological deficits were observed in 2 cases after the surgery which caused systemic hypotention or prolonged occlusion of ICA during operation. One case, which had the shunt tube occlusion during surgery, had a permanent hemiparesis and another patient died from septicemia. For avoiding these complications following points are thought to be noteworthy:<BR>1) To maintain the systemic blood pressure as high as the level of the preoperative state and to avoid the falling of the perfusion pressure less than 100 mmHg at least.<BR>2) To shorten the clamping time of the carotid artery.<BR>3) To remove the atheromatous plaque sufficiently. For these purposes, we are trying to perform CEA as follow:<BR>1) Under various monitors, such as stump pressure checking, local perfusion pressure measurement, systemic pressure measurement, EEG and blood gas if necessary.<BR>2) Using the T-shaped internal shunt in all cases.<BR>3) And with postreconstruction angiography.
- The Japanese Society on Surgery for Cerebral Strokeの論文