椎骨動脈, 鎖骨下動脈への外科的侵襲の経験

概要

論文の詳細を見る
In the last three years, we have experienced four cases of occlusive disorder of the vertebral and common carotid arteries that showed cerebral ischemic attacks: RIND (one case), TIA (two cases) and minor stroke (one case). In all cases, transcervical approach was used to manipulate either the subclavian artery or the vertebral artery. In the first and the fourth case, saphenous vein graft was interposed between the subclavian artery and either the external or internal carotid artery in order to reconstruct the obstructed carotid blood flow. In the second case, a stenosed orifice of the right vertebral artery was corrected by patching with using a vein graft. In the third case, the coiling of the vertebral artery at it's origin was straightened by stretching. The operative result in every case was successful and the patient have not suffered from the further ischemic attack or stroke. The only operative complication which was observed in the case 3 was a transient Horner's syndrome. If the vascular graft is propery interposed, a highly risky thoracotomy can be avoided and substituted by a simple transcervical approach in the reconstructive sugery of the branches of the aortic arch.
The Japanese Society on Surgery for Cerebral Strokeの論文