両側総頸動脈閉塞症に対する大伏在静脈片による頸部内頸動脈—鎖骨下動脈吻合術の1例

Subolavian Artery to Internal Carotid Artery Bypass with Saphenous Vein Graft for the Treatment of Bilateral Common Cartid Artcry Occlusion;A case report

I．はじめに

　症候性の総頸動脈閉塞症は稀な疾患であり^6），両側の場合はさらに頻度が少ない．われわれは，虚血症状で発症した両側総頸動脈閉塞症に対して，大伏在静脈による鎖骨下動脈一内頸動脈吻合術を施行し良好な結果を得たので報告する．

A case of left common carotid artery occlusion, which was treated by a saphenous vein graft, is reported. A 49-year-old right handed male was admitted to the hos-pital because of right hemiparesis and aphasia. These symptoms disappeared spontaneously two weeks after admission. However, visual acuity remained impaired on the left side clue to occlusion of the central retinal artery. Angiography revealed complete occlusion of the common carotid arteries as well as patency of the inter-nal carotid arteries on both sides. PET and ¹²³I-IMP-SPECT studies showed hypoperfusion in the left cere-bral hemisphere. To restore the blood flow as well asto remove the source of the emboli, endoarterectomy was performed on the left internal carotid artery. This was followed by a saphenous vein graft between the left subclavian and the internal carotid artery. Postop-erative angiography revealed patency of the bypass, and a SPECT study revealed increased blood flow in the left cerebral hemisphere.

The patient has remained in stable condition during the following 30 months with no neurological problems. We conclude that in the treatment of complete occlu-sion of the common carotid artery and subsequent cere-bral hypoperfusion, a bypass graft between the internal carotid and the subclavian artery is quite effective, and that the site of the bypass graft should carefully be sought for by using preoperative angiographic studies.