高度内頸動脈狭窄症例の冠動脈病変

Proportion of Coronary Artery Disease in Patients with Severe Carotid Artery Stenosis

要旨　頸動脈高度狭窄例の冠動脈病変頻度を検討した．対象は，連続36例の頸動脈狭窄例である．36例中25例に冠動脈造影検査を，3例に心筋シンチを施行したが，残りの8例は検査未施行であった．冠動脈病変は，0枝疾患が7例，1枝疾患が6例，2枝疾患が6例，左主幹部を含む3枝疾患が9例で，残りの8例は不明であった．約1/3の症例が重症冠動脈疾患例であった．冠動脈バイパス術施行が3例，冠動脈形成術施行が6例であった．冠動脈造影検査施行の25例中14例に冠1血行再建が必要であった．下肢動脈狭窄症例を8例に認めた．頸動脈高度狭窄を有する全身動脈硬化high risk群は冠動脈病変，下肢動脈硬化所見を認めることが多く，全身の血管検索が必須である．

　To evaluate the prevalence of coronary artery disease (＞75%) in patients with advanced carotid arterystenosis (≧60%), coronary arteriography was performed after selective cerebelar angiography. We studied36 consecutive patients with advanced carotid arterystenosis. Among them, coronary arteriography wasperformed in 25 patients, myocardial 201-thalliumscintigraphy was performed in 3 patients, and theremaining 8 patients had no examination. There was nostenosis in 19% of the cases, one-vessel disease in 17%.two-vessel disease in 17%, left main trunk stenosis or three-vessel disease in 25% and, in the remainder, theextent of the stenosis was unknown. Severe coronaryartery disease was observed in a third of all patients.Coronary aorta bypass surgery was carried out in 3patients and coronary angioplasty was performed in 6patients. Coronary revascularization was necessary in14 of 25 patients who had undergone coronary angiography. Eight patients had arteriosclerosis obliterance.

　In conclusion, it is necessary to evaluate coronaryatherosclerosis and/or atherosclerosis of the lowerextremities in patients with carotid artery stenosis.