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Neurological Surgery No Shinkei Geka Volume 36, Issue 12 （December 2008）

Neurological Surgery 脳神経外科 36巻12号（2008年12月発行）

Japanese English

研究

頸動脈内膜剝離術後における反対側内頸動脈の自然歴 Natural Course of the Carotid Artery Contralateral to Carotid Endarterectomy in Japan 岩﨑素之 ¹ , 黒田敏 ¹ , 安田宏 ² , 中山若樹 ¹ , 斉藤久壽 ² , 岩﨑喜信 ¹ Motoyuki IWASAKI ¹ , Satoshi KURODA ¹ , Hiroshi YASUDA ² , Naoki NAKAYAMA ¹ , Hisatoshi SAITO ² , Yoshinobu IWASAKI ¹ ¹北海道大学大学院医学研究科神経外科 ²札幌麻生脳神経外科病院 ¹Department of Neurosurgery,Hokkaido University Graduate School of Medicine ²Sapporo Azabu Neurosurgical Hospital キーワード： carotid artery , carotid endarterectomy , disease progression , contralateral side , Japan Keyword: carotid artery , carotid endarterectomy , disease progression , contralateral side , Japan pp.1103-1107

発行日 2008年12月10日 Published Date 2008/12/10

DOI https://doi.org/10.11477/mf.1436100851

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Ⅰ．はじめに

　内頸動脈高度狭窄病変においては，症候性，無症候性を問わずcarotid endarterectomy（以下，CEA）の有効性が認められている^5,6)．しかし，未だ本邦では，術後の反対側頸部内頸動脈の長期経過についての報告は少ない．一方，欧米での報告では，CEA後に反対側内頸動脈の狭窄が進行する確率が高いとされている．わが国においても生活習慣の欧米化に伴い，冠動脈病変を含む全身の動脈硬化性疾患が増加する背景を考慮すると，CEA術後の長期フォローアップは重要であると考えられる．

　今回，われわれは，一側内頸動脈狭窄病変に対して実施したCEA術後の経過観察期間中に反対側内頸動脈に狭窄病変の進行が確認された例について，危険因子などの臨床像を検討したので報告する．

　There are few studies that describe long-term outcome of the carotid artery contralateral to carotid endarterectomy (CEA) in Japan. This study, therefore, was aimed at assessing the incidence and clinical features of patients whose contralateral carotid artery showed progression to significant stenosis (more than 70%). This study included 130 patients who underwent CEA for internal carotid artery stenosis between 1998 and 2007. During follow-up periods of a mean of 34.3 months, MR angiography or 3-dimenional CT angiography was performed every 6 or 12 months. Risk factors including hypertension, diabetes mellitus, hyperlipidemia, and coronary artery disease were also evaluated to clarify the significant predictors for disease progression of the carotid artery contralateral to CEA. The results were that, the carotid artery contralateral to CEA showed disease progression to significant stenosis (＞70%) in 12 of 130 patients (9.2%). The interval between CEA and disease progression of the carotid artery contralateral to CEA ranged from 13 to 103 months (mean, 50.7 months). Of these 9 patients underwent CEA for contralateral carotid artery stenosis to prevent ischemic stroke. Multiple logistic regression analysis revealed that there were no predictors for disease progression of the carotid artery contralateral to CEA during follow-up periods. This is the first report that has analyzed the incidence and clinical features of disease progression of the carotid artery contralateral to CEA in Japan. Its incidence is not low in Japan, and careful long-term follow-up would be essential to prevent additional stroke occurrence in patients who undergo CEA.