３Ｄ‐ＣＴＡによる頸動脈狭窄症治療後の経過観察

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概要

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• We previously reported the usefulness of three-dimensional (3D) CT angiography for perioperative evaluation of carotid endarterectomy (CEA) to avoid several complications in conventional angiography, which was reported to be 1.2% in ACAS. We describe here the utility of 3D-CTA in follow-up at an outpatient clinic made possible by the clear and accurate view provided by 3D-CTA. Forty-five of 64 consecutive CEA cases were examined with 3D-CTA (mean age 67.7 y/o, male: female=12:4) and 16 consecutive CAS cases (mean age 72.6 y/o, male:female=39:6) were examined with 3D-CTA preoperatively, 1-week, 3 to 6-months and 1 to 2 years after surgical intervention, reconstructing into volume rendering (VR), maximum intensity projection (MIP) and multiplanar reconstruction (MPR) images. Three-dimensional CT angiography visualized subtle changes such as small dents caused by vascular tourniquets used in operation, which mostly diminished in 1 year. Dilatation of external carotid artery was shown along with amelioration of internal carotid artery, though 19.4% of external carotid arteries demonstrated transient narrowing or occlusion. Restenosis after CEA occurred in 4 cases (6.3%), 2 of which were subjected to CAS. The course of restenoses as well as the state after stenting were clearly delineated with 3D-CTA. Sagittal and axial MPR images were useful in confirmation for lumen. Though DSA remains the gold standard in some facilities in follow-up studies after CEA, its use is declining due to the complications it presents and to the development of other diagnostic modalities. Duplex US is a handy, non-invasive, real-time technique but is limited due to its operator dependency and low resolution. MR angiography is promising, though it is still being developed. Three-D CTA with a high-performance workstation provides detailed images with satisfactory information for postoperative follow-up studies in outpatient clinics, though it also presents the problems of X-ray exploration and allergic reaction to contrast media.

• 一般社団法人 日本脳卒中の外科学会の論文

一般社団法人 日本脳卒中の外科学会 | 論文

• 頸部内頸動脈のｎｅａｒ　ｏｃｃｌｕｓｉｏｎに対するＳＴＡ‐ＭＣＡ吻合術
• 未破裂脳動脈瘤の外科手術の合併症とその対策―慢性硬膜下血腫および後頭蓋窩出血の発生予防―:―慢性硬膜下血腫および後頭蓋窩出血の発生予防―
• 周術期管理指針に基づいたもやもや病に対する血行再建術:―急性期脳血流評価と予防的降圧の効果と限界―
• 未破裂脳動脈瘤クリッピング術の治療成績‐脳動脈瘤手術初心者の経験‐:―脳動脈瘤手術初心者の経験―
• 脳底動脈上小脳動脈分岐部動脈りゅう５８手術例の検討

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