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Neurological Surgery No Shinkei Geka Volume 25, Issue 8 （August 1997）

Neurological Surgery 脳神経外科 25巻8号（1997年8月発行）

Japanese English

研究

頸部頸動脈狭窄病変由来の微小塞栓発生に影響を及ぼす因子の検討 Analysis of factors related to microemboli in cases with internal carotid artery stenosis 秋山義典 ¹ , 善本晴子 ² , 長束一行 ² , 戸高健臣 ¹ , 野村素弘 ¹ , 澤田元司 ¹ , 森本将史 ¹ , 橋本信夫 ¹ Yoshinori AKIYAMA ¹ , Haruko YOSHIMOTO ² , Kazuyuki NAGATSUKA ² , Tatemi TODAKA ¹ , Motohiro NOMURA ¹ , Motoshi SAWADA ¹ , Masafumi MORIMOTO ¹ , Nobuo HASHIMOTO ¹ ¹国立循環器病センター脳血管外科 ²国立循環器病センター内科脳血管部門 ¹Department of Cerebrovascular Surgery, National Cardiovascular Center ²Department of Medicine, Cerebrovascular Division, National Cardiovascular Center キーワード： internal carotid artery stenisis , transcranial Doppler sonography , microemboli Keyword: internal carotid artery stenisis , transcranial Doppler sonography , microemboli pp.707-712

発行日 1997年8月10日 Published Date 1997/8/10

DOI https://doi.org/10.11477/mf.1436901431

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Abstract 文献概要
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I．はじめに

　1982年にAaslidらにより開発されたTranscranial Doppmer法（以下TCD）により，頭蓋骨を介して頭蓋内主要血管の血流を測定することが可能となった^1）．更に，in vitroでの実験や動物実験にて，粒子性塞栓子がchirp音を伴った異常波形（high intensity transient sig—nal，HITS）として検出できることが報告された^9,13）．この方法を用いて頸部頸動脈狭窄病変由来の微小塞栓を，同側中大脳動脈の血流波形を記録することにより検出しようとする試みがなされている^{3,10,11,14,17,19）}．われわれも，TCDによる微小塞栓の検索から，微小塞栓の検出と頸部頸動脈狭窄病変を原因とする脳卒中発生が密接に関連していることを報告した^2）．この結果にもとづき，今回われわれは，微小塞栓発生に影響を及ほす因子につき検討したので報告する．

Transcranial Doppler ultrasound (TCD) has been used to detect microemboli in cases with extracranial internal carotid artery stenosis. However, the mecha-nism causing microemboli has remained unclear. The purpose of this study is to clarify clinical characteristics and circumstances associated with the genesis of TCD-detected microemboli. Ninety-one cases with more than 30% stenosis of the internal carotid arteries were stu-died. TCD monitoring was carried out for an hour at the ipsilateral middle cerebral artery of each case using a 2-MHz pulse-wave transcranial Doppler device, and high intensity transient signals were counted as mi-croemboli. Digital subtraction angiography, magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) were also performed in all cases. Microemboli were detected in 30 of 91 cases. Microemboli were significantly well detected in cases with a history of ischemic event and/or cerebral infarction recognized by MRI. Detection of microemboli had no relation to sex, age or clinical risk factors (hypertension, hypercholesterolemia, diabetes mellitus and smoke habituation). In contrast, detection of mi-croemboli was significantly related to decrease in cere-bral blood flow recognized by SPECT, severity of ste-nosis and wall irregularity of lesion recognized by angiography. Microemboli can be found in a signifi-cantly high percentage of these clinical conditions, which may be risk factors for embolic stroke caused by extracranial internal carotid artery stenosis.