脳梗塞患者の10年間の予後—脳動脈写所見と死亡

LONG-TERM PROGNOSIS OF CEREBRAL INFARCTION : INFLUENCE OF ARTERIAL STENOTIC LESION FOR SURVIVAL

I．はじめに

　虚血性脳血管疾患患者の予後に対する狭窄性脳動脈病変の意義を検討することは，その後の治療とくに最近注目されている血行再建術の効果を考える上に重要である。従来，脳動脈所見と予後については多くの報告があるが，欧米においては頸動脈病変に重点をおいたものが多く，頭蓋内病変を主体とする日本人の脳梗塞を考えるには必ずしも十分ではない。

　私どもは昭和37年以来，脳梗塞患者について発症後10年間の予後に関するprospective studyを行つた^1）。その成績の中から，この報告では脳血管撮影所見と死亡との関連に限つて検討した。

Cerebral four vessel angiography was performed in 85 patients with non-embolic cerebral infarction and followed for ten years.

Of 45 patients with arterial stenosis of 25 percent or more, 21 (46.7%) survived at 5 years and 12 (26.7%) fat 10 years after onset of the stroke. In contrast, survivors of 45 patients with stenosis less than 25 per cent or with no stenotic lesion, were 35 (87.5%) at 5 years and 29 (72.5%) at 10 years after the onset. The survival rate of the former patients group was lower significantly than the expected survival rate in a general population.

Arterial stenosis of 25 per cent or more suggested a trend of poor prognosis in patients with multiple stenosis, especially those of bilateral internal carotid arteries, and of better prognosis in patients with stenosis in vertebrobasilar system. Patients with stenosis of 50 per cent or more in sphenoidal portion of the middle cerebral artery seemed to have a poor prognosis than those in the internal carotid artery.