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Neurological Surgery No Shinkei Geka Volume 42, Issue 9 （September 2014）

Neurological Surgery 脳神経外科 42巻9号（2014年9月発行）

Japanese English

研究

頚動脈プラーク性状と臨床症状に対して加齢が及ぼす影響 Contribution of Increasing Age to Carotid Plaque Morphology and Symptoms 引地堅太郎 ¹ , 石川達哉 ¹ , 宮田元 ² , 師井淳太 ¹ , 河合秀哉 ¹ , 竹中俊介 ¹ , 吉岡正太郎 ¹ , 宇田賢司 ³ , 岡田健 ¹ , 小林慎弥 ¹ , 齋藤浩史 ¹ , 田邉淳 ¹ , 古谷伸春 ¹ , 安井信之 ⁴ , 鈴木明文 ¹ Kentaro HIKICHI ¹ , Tatsuya ISHIKAWA ¹ , Hajime MIYATA ² , Junta MOROI ¹ , Hideya KAWAI ¹ , Syunsuke TAKENAKA ¹ , Shotaro YOSHIOKA ¹ , Kenji UDA ³ , Takeshi OKADA ¹ , Shinya KOBAYASHI ¹ , Hiroshi SAITO ¹ , Jun TANABE ¹ , Nobuharu FURUYA ¹ , Nobuyuki YASUI ⁴ , Akifumi SUZUKI ¹ ¹秋田県立脳血管研究センター脳神経外科学研究部 ²秋田県立脳血管研究センター脳神経病理学研究部 ³新行橋病院脳神経外科 ⁴仙台東脳神経外科病院脳神経外科 ¹Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita ²Department of Neuropathology, Research Institute for Brain and Blood Vessels-Akita ³Department of Neurosurgery, Shin Yukuhashi Hospital ⁴Department of Neurosurgery, Sendai East Neurosurgical Hospital キーワード： carotid plaque , age , morphology , symptom Keyword: carotid plaque , age , morphology , symptom pp.829-835

発行日 2014年9月10日 Published Date 2014/9/10

DOI https://doi.org/10.11477/mf.1436102326

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Ⅰ．はじめに

　頚部頚動脈狭窄症は一過性脳虚血発作（transient ischemic attack：TIA）や脳梗塞の原因となり，10～20%で虚血性合併症を来すといわれている¹⁾．その要因として，高血圧症，脂質代謝異常症などの基礎疾患や，喫煙などの生活習慣，頚部放射線治療の既往³⁾などがあるが，なかでも加齢は重要な要因の1つとされている⁴⁾．しかし加齢が頚動脈病変へ及ぼす影響について検討した報告は極めて少ない．今回われわれは頚動脈内膜剝離術（carotid endarterectomy：CEA）にて摘出した頚動脈プラークをサンプルとして，加齢によると思われる頚動脈プラークの組織学的な変化と，症候に与える影響について検討したので報告する．

　Objective:Aging is considered to cause atherosclerotic changes in the carotid artery, but few studies have evaluated this relationship. In this study, we used carotid plaques removed from patients with carotid artery stenosis and investigated how aging contributes to carotid plaque morphology and symptoms.

　Materials and Methods:A total of 60 patients（55 men, 5 women;mean age, 70.5 years;range, 53-85 years）treated at our hospital between January 2009 and April 2012 were enrolled in this study. All patients underwent carotid endarterectomy;their carotid plaques were stained with hematoxylin-eosin and/or Elastica-Masson stain and examined by a pathologist. Using these data, the carotid systolic velocity and plaque morphology were analyzed considering the age by decade as well as the symptomatology.

　Results:Of the 60 patients, 29 were symptomatic（transient ischemic attack（TIA）in 8 patients;infarction in 20;and amaurosis in 1). Symptoms were less common as patient age increased. The incidence of TIA also tended to decrease with an increase in age, although the opposite trend was seen with infarction. In plaque morphology, the presence of active plaque, macrophage, inflammatory infiltration, and capillary angiogenesis decreased as age increased, while the presence of degenerative plaques, decrease in smooth muscle cell number, and calcification inversely increased. Active, degenerative, and combined（active/degenerative）lesions are statistically unrelated to symptoms as well as systolic velocity（cm/sec）at the carotid stenosis. The rates of hemorrhagic lesions were similar among decades, but the lesion statistically contributed to increasing symptoms（p＝0.0045）and increasing systolic velocity（p＝0.031).

　Conclusion:Increasing age contributes to morphological changes in carotid plaques and symptoms. When hemorrhagic lesions are suspected in carotid plaques, patients will be symptomatic and may require surgery.