血管造影による頸部頸動脈閉塞性病変の診断および摘出標本との対比

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Determination of angiographic indication for carotid endarterectomy (CEA) requires a precise estimation of degree of stenosis or presence of ulceration. The authors have proposed a new angiographic method and utilized it for diagnosis of pathologies at the cervical carotid bifurcation since 1974. The method consists of measurements of a relative luminal diameter of the carotid lumen to a diameter of the common carotid artery (A value). The measurements were taken at 6 standard points which were determined by a distance (decided by the A value) from the bifurcation.<BR>The present study was undertaken to compare the angiographic diagnosis by our method with actual measurements of the tissue removed during CEA. Fifteen specimens, removed without extensive damage to the tissue, were chosen for this study and included 7 stenotic and 8 ulcerated plaques.<BR>Results of comparative measurements indicated that the degree of stenosis, actually measured, was always larger than that measured angiographically. The difference was most pronounced (16% average) in stenotic lesions of a circular type, involving all around of the vessel wall, than that of a semi-circular leison, located in the posterior wall of the bifurcation. The angiographic diagnosis of ulcerated plaque correlated well to the macro and micro scopic findings of the specimen, except in the microulcer at the steep plaque. Some of the microulcers appeared to have a complete covering of regenerated endothelial cell sin scan electron microscopic observation.<BR>The authors proposed to add 20% to the angiographic stenotic degree for the circular type stenosis and a careful angiography from multiple directions is needed for diagnosis of an unhealed microulcer at the steep Plaque.
The Japanese Society on Surgery for Cerebral Strokeの論文

血管造影による頸部頸動脈閉塞性病変の診断および摘出標本との対比

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