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Neurological Surgery No Shinkei Geka Volume 25, Issue 5 （May 1997）

Neurological Surgery 脳神経外科 25巻5号（1997年5月発行）

Japanese English

研究

頸動脈動脈解離に対する治療方法と長期予後の検討 Management and long-term follow-up results in patients with carotid artery dissection 宇野昌明 ¹ , 上田伸 ¹ , 新野清人 ¹ , 西谷和敏 ¹ Masaaki UNO ¹ , Shin UEDA ¹ , Kiyohito SHINNO ¹ , Kazutoshi NISHITANI ¹ ¹徳島大学脳神経外科 ¹Department of Neurological Surgery, School of Medicine, The University of Tokushima キーワード： dissection , treatment , outcome Keyword: dissection , treatment , outcome pp.417-423

発行日 1997年5月10日 Published Date 1997/5/10

DOI https://doi.org/10.11477/mf.1436901386

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Abstract 文献概要
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I．はじめに

　頸動脈動脈解離は以前は非常に少ないと言われていたが^16），その概念の普及と診断法の進歩により最近では症例数が増加している^{1,2,5-10,12-14）}．原因としては動脈硬化を基盤としたものや外傷を基因としたものがある^8,13）．大部分の症例は保存的加療がなされてきたが，その治療方法，長期follow-upの成績についての報告は少ない^13,18,19）．今回われわれはその治療方法の選択と長期予後について検討したので報告する．

The recognized incidence of extra- and intracranial carotid artery dissection has increased concomitantly with the progress and development of diagnostic methods. However, management for this condition is still controversial. We report in the present study the management and long-term follow-up results of 15 pa-tients with carotid artery dissection.

Mean age of the patients at onset was 47.8 years old, and male/female ratio was 12: 3. Two patients were considered to be traumatic dissections and the other 13 patients were spontaneous dissections. Dissection occur-red in 10 patients at the extracranial carotid artery, in 4 at the intracranial carotid artery and in 1 at the middle cerebral artery. Nine of 15 patients demonstrated hemi-paresis and 5 complained of headache or facial pain. However, it was not possible to identify a characteristic symptom of dissection. Final diagnosis of dissection was made by cerebral angiography in all patients. Se-rial angiography was carried out in 10 of those, and 5 of the 10 patients showed some improvements of dis-section in the cerebral angiogram.

Treatment for those patients was selected according to the neurological and angiographical changes. Five patients were managed conservatively and 10 patients underwent surgical revascularization. During the fol-low-up period (mean 77.6 months), none of them showed any symptoms of reattack, and all but one, who died of heart failure 193 months after revascular-ization surgery, have lived independently.

Although diagnosis of dissection was difficult be-cause of the lack of characteristic symptom,serial angiography was a useful method for diagnosis and adequate management has led to a good clinical out-come.