頸部頸動脈高度狭窄病変例はは高率に冠動脈病変を合併している

Severe Carotid Artery Stenosis in the Neck is Frequently Associated with Coronary Heart Disease

　Carotid endarterectomy（CEA）の適応となるような頸部頸動脈狭窄性病変15例において，CEA後の長期的生命予後に関与する血管合併症，特に冠動脈病変に重点をおき検索した。合併症として高血圧，糖尿病，高脂血症をそれぞれ87％，40％，57％と高率に認めた。また，冠動脈病変を除いた何らかの血管合併症を27％に認めた。15例中3例では先行する虚血性心疾患がみられ，このうち1例は脳梗塞急性期に狭心症を発症した。虚血性心疾患を認めなかった12例中4例でCEA後の脳血管撮影の際に冠動脈造影を行ったが，3例に狭窄性病変を認めた。他の8例のうち，安静時心電図上異常を認めなかった1例でCEA後1年目に狭心症を発症し，3枝病変であった。以上から頸部頸動脈高度狭窄性病変例は，高率に冠動脈病変を合併していることが示唆された。すなわち，既往歴や安静時心電図の検索のみでは必ずしも充分ではなく，積極的に冠動脈造影を行う必要があると考えられた。

We have reviewed 15 cases of carotid artery stenosis in the neck, consisting of 11 patients with cerebral ischemia and 4 asymptomatic patients, in relation to associated coronary heart disease. The 15 patients had systemic complications, including hypertension in 87%, diabetes mellitus in 40% and heperlipidemia in 57%. Systemic vascular compli-cations other than coronary heart disease were present in 27% of the patients.

Three of the 15 patients had a history of ischemic heart disease and had been treated by cardiologists. One patient developed angina pectoris on the second day of a cerebral ischemic attack. Coronary angio-graphy (CAG) and simultaneous cerebral angiogra-phy following carotid endartectomy (CEA) were performed 4 of the remainng 12 patients, who had symptoms or history of ischemic heart attacks. Three of these four patients had stenotic lesions in their coronary arteries. Another one patient among the remaining 8 developed angina pectoris one year after undergoing CEA. This patient had 3-vessel coronary artery disease.

These findings suggest that a strong correlationbetween stenotic lesions of the carotid arteries in the neck and coronary heart disease, with or with-out episodes of ischemic heart disease. CAG should be strongly recommended in such patients to assessthe severity of complicating ischemic heart disease and to improve the prognosis following CEA.