頸動脈狭窄の外科治療―頸動脈内膜切除術

Surgical treatment, CEA, for the carotid artery stenosis

はじめに

　頸部頸動脈狭窄病変に対する確立された手術法として，頸動脈内膜切除（剥離）術：CEA（carotid endarterectomy）がある。近年本邦においても頸動脈閉塞性病変の増加がいわれ，CEAの重要性が注目されてきている（図1）。病変病理形態の特徴よりみた外科治療の意義，手術適応に関する最近の研究成績，CEA手技のポイントと話題，および本邦でのCEAの現状と問題点につき概説する。

In the recent large randomized trials performed in North America and Europe, beneficial effect and guidelines of carotid endarterectomy (CEA) have been reconfirmed for symptomatic and asymptomatic patients with high-grade carotid artery stenosis. These studies also demonstrate that successful results of CEA are dependent upon surgeons having minimum perioperative morbidity and mortality rates. In each process of CEA, including arterial preparation, removal of atheroma plaque and suture of arteriotomy, we have to know some points to perform surgical procedures with minimum complications.