頭蓋外・内頸動脈病変に対する外科的療法とその遠隔成績

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Fifty-two cases of occlusive cerebrovascular disease of the extracranial carotid artery were treated surgically in our service for last four and a half years. CEA was performed on 31 cases with one bilateral case, EIAB on 15 cases with one bilateral case and reconstruction of the internal carotid artery on 4 cases. Thirteen of 52 cases were either TIA or PRND and 24 cases of minor completed stroke. Repeated episodes of ischemic attack had occured in 27 of the 52 cases, the remainders had only once. Shifting patterns of the repeated episodes were examined in Table 3. Repeated TIAs were noted in 7 cases. In 8 cases TIAs shifted to a minor ccompleted stroke. Repeated number of TIAs were demonstrated in Table 3. The mean number of episodes of the TIA was 2.87±1.8 SD.<BR>The follow up periodes of 48 cases were ranged from three months to four and a half years with a mean duration of 2.1 years. Two patients died from myocardial infarction, one was 2 years after the opration and the other six months. One of them had shown AF on the preoperative EKG but, the other patient showed a normal EKG. Recurrent attacks of ischemic CVD had occured in two cases.<BR>A fifty six year old female, who had several TIAs with 60%stenosis of the internal carotid artery preoperatively, had two short episodes less than 10 minutes of disarthria two years after CEA. CT scan and carotid angiogram were examined after each episode but no abnormal findings were revealed. Stenosis of the left ICA had disappeared completely and the inner wall of ICA was smooth. Only the EEG showed a questionable paroxysmal abnormality.<BR>In another case a fifty year old male had an attack of the monoparesis of the right upper extremity one and a half years after the EIAB. His preoperative diagnosis was progressing stroke with left ICA occlusion. Postoperative patency of the bypass was good. There was no change in the CT scan and the angiogram after the episode. No further attack had occured. We could not explain the pathogenesis of these recurrent cases.<BR>It has been reported by us concerning procedures preventing against the operative complication of CEA. In this paper, it was also discussed the necessity of the postreconstruction angiography during the surgery, which is a convenient and reliable method for confirmation whether CEA is performed satisfactorily or not.
The Japanese Society on Surgery for Cerebral Strokeの論文

頭蓋外・内頸動脈病変に対する外科的療法とその遠隔成績

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