Major artery の閉塞性病変を有するminor stroke-Non-surgical course よりみた外科的治療の問題点-

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概要

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• The clinical features of ischemic cerebrovascular diseases differ largely depending on the degree of collaterals or on the site of arterial occlusion. Following lots of neurosurgical therapeutic trials in ischemic cerebrovascular diseases, it has been said that the indication of sugical anastomosis is such stroke patients as suffering from minor stroke like TIA or RIND. In order to assess the reasonability of surgical intervention in patients having minor stroke and major cerebral artery occlusion, the non-surgical course of 34 patients having internal carotid artery or middle cerebral arterial trunk occlusion were observed. They all were judged as minor stroke, who had neither remarkable consciousness disturbance, complete hemiplegia, nor severe visceral complication. In the present follow-up study, attention was focused in two points; (1) the incidence of clinical deterioration either because of reattack or newly developed completed stroke, (2) the alteration of development of completed stroke. Consequently, 9 cases (26%) developed completed stroke within a month, 6 cases (18%) repeated minor stroke, 10 cases (30%) developed severe visceral complication in the follow-up intervals (mean 17.5 months). Cases with atrial fibrillation showed the development of completed stroke more frequentry than those without. In addition, cerebral angiographies repeatedly done at the deterioration stage apparently showed alteranative findings compared with those at the onset. They can be divided into two categories; recanalization of the occluded artery and the progres-sion of occlusion on the blood passage through collateral. These data can afford several informations as for the indication of the reconstructive surgery in patients having occlusive cerebrovascular diseases from major cerebral artery occlusion. We assume that especially cases with atrial fibrillation must be considered their protection against the development of completed stroke even when their neurological deficits are judged as minor, and that sugical intervention might be indicated for this purpose.

著者

• 西出 正人

  阪和病院脳卒中診療部

• 門田 永治

  阪和病院脳卒中診療部

• 入野 忠芳

  阪和病院脳卒中診療部)

• 小西 英治

  阪和病院脳卒中診療部

• 金田 平夫

  阪和病院脳卒中診療部

• 南 卓男

  阪和病院脳卒中診療部

• 前田 泰孝

  阪和病院脳卒中診療部

• 種子田 護

  阪和病院脳卒中診療部

• 渡辺 学

  阪和病院脳卒中診療部

• 入野 忠芳

  阪和病院脳卒中診療部

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