浅側頭動脈—中大脳動脈Bypass手術の脳梗塞予防効果

Prevention of relapsing cerebral ischemia by the EC-IC bypass: Reevaluation of results of the EC-IC bypass international cooperative study and those of our cases.

はじめに

　頭蓋外頭蓋内動脈吻合術EC-IC bypassは1984年に終了した国際共同研究で"脳梗塞再発予防に効果がない"^8）とする結論が出されて以来，北米のactiveな数施設を除いてほとんど行なわれなくなった（以前の20％に減少^31））とされている。本邦でも最近の手術数は共同研究以前の60％弱に減少している^15）。本稿ではEC-ICbypass共同研究の成績をわれわれがどう受けとめているか，適応をどう決定しようとしているか，今後どのような研究がなされるべきかについて自験例をもとに考察してみたい。

We sincerely have to accept the results of the international cooperative study namely failure to prevent relapsing cerebral ischemia by the EC-IC bypass on the whole, but on the other hand we have to be aware of the probable preventive effect of the EC-IC bypass observed in some subgroup of the same study namely in the Japanese-Taiwan group. We would like to point out that our experience, for example, about the middle cerebral artery stenosis is contradictory to the result of the cooperative study : in this group, the surgical group was inferior to the medical group with statistical significance in stroke prevention in cases of the study and in this very group the surgical group has revealed to have tendency to be superior to the medical group in the Asian group and in our experienced cases.