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Neurological Surgery No Shinkei Geka Volume 23, Issue 2 （February 1995）

Neurological Surgery 脳神経外科 23巻2号（1995年2月発行）

Japanese English

研究

頸部頸動脈のPTA（Percutaneous Transluminal Angioplasty） Percutaneous Transluminal Angioplasty for Cervical Carotid Artery Stenosis 山村明範 ¹ , 大山浩史 ¹ , 松野太 ¹ , 石黒雅敬 ¹ , 中川俊男 ¹ , 端和夫 ² Akinori YAMAMURA ¹ , Hiroshi OYAMA ¹ , Futoshi MATSUNO ¹ , Masanori ISHIGURO ¹ , Toshio NAKAGAWA ¹ , Kazuo HASHI ² ¹新さっぽろ脳神経外科病院 ²札幌医科大学脳神経外科 ¹Shinsapporo Neurosurgical Hospital ²Department of Neurosurgery, School of Medicine, Sapporo Medical University キーワード： Percutaneous transluminal angioplasty , Internal carotid artery stenosis , Cerebral infarction Keyword: Percutaneous transluminal angioplasty , Internal carotid artery stenosis , Cerebral infarction pp.117-123

発行日 1995年2月10日 Published Date 1995/2/10

DOI https://doi.org/10.11477/mf.1436900974

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Abstract 文献概要
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Ⅰ．はじめに

　平成3年8月より平成5年12月までに頸部頸動脈狭窄16症例（17病変）に対してPTAを行い，良好な結果を得たのでPTAの有用性について報告する．

Percutaneous transluminal angioplasty (PTA) was attempted in 16 patients (17 procedures) with cervical internal carotid artery (ICA) stenosis.

Among the 16 patients, 14 were male and 2 were female aged from 44 to 76 years (average 63.4years).

One had cerebral infarction on the acute stage, and the other 15 were in the chronic stage. On CT scan and MRI, there were nine multiple lacunar infarctions and seven watershed infarctions. On angiographical find-ings, 13 had Rt.-ICA stenosis and 4 had Lt. ICA steno-sis. Stenotic lesion existed beyond the level of the third cervical vertebral body in eleven cases, and so-called long segmental stenosis ranged from 3 to 5 cervical ver-tebral bodies in 3 cases. Before PTA, 14 patients under-went a balloon occlusion test for 3 to 20 minutes (average 9 minutes). Neurological symptoms of hemi-paresis or sensory disturbance occurred in 3 patients during balloon inflation, but these disappeared com-pletely after balloon deflation. It took from 1.5 to 2 hours (average 1.7 hours) to carry out PTA including the balloon occlusion test. All cases had satisfactory re-sults with no morbidity or mortality. The mean stenosis ratio of pre-PTA, approximately 80% (55-93%), im-proved to that of 22% (0-50%) after PTA. Bradycardia and hypotension occurred transiently in 9 cases during and after PTA, but no symptoms remained by atropine sulfate and catecholamine infusion intravenously. In the following 1 to 26 months (mean 9.0 months) after PTA, 3 cases restenosed. The restenosis was recog-nized by MR angiography after 8 to 26 months (average 15.7 months) of PTA. One case bad PTA again, and CEA was performed on the other 2 cases. Our experience has shown that PTA of an ICA le-sion is an applicable form of treatment.

PTA may be the first-choice therapy for high risk patients or surgically inaccessible high lesions of the ICA. With further improvement of the balloon catheter systems, PTA may become the first-choice therapy for carotid artery stenosis instead of CEA.