両側の血行再建を行った内頚動脈狭窄症　　頚動脈ステント留置の活用:─頸動脈ステント留置の活用―

概要

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Carotid endarterectomy (CEA) is a well-established procedure for patients with high-grade carotid stenosis. But we sometimes have difficulty in the management of patients with bilateral severe carotid stenosis, most of whom have severe hemodynamic failure in cerebral circulation. These patients can be at risk during CEA because of the possibility of poor collateral circulation during clamping of the internal carotid artery. We reviewed 8 patients with bilateral severe carotid stenosis and analyzed the safety and efficacy of endoluminal revascularization in this subgroup. We performed carotid angioplasty and stenting (CAS) for one side before CEA of the other side in 4 patients, and CAS for both sides in 3 patients. The perioperative complications include all strokes within 30 days, 1 patient had transient aphasia after CEA, and 1 patient who was treated by CAS for both sides had transient left hemiparesis after stenting for the symptomatic side. None had permanent neurological deficit periprocedurally. Although we need long-term follow-up, our data of early experience suggest that CAS for one or both sides of bilateral carotid stenosis can be an effective strategy in the management of this subgroup of patients.
一般社団法人日本脳卒中の外科学会の論文