雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 29, Issue 1 （January 2001）

Neurological Surgery 脳神経外科 29巻1号（2001年1月発行）

Japanese English

症例

冠動脈狭窄と無症候性頸動脈狭窄の合併に対する一期的手術の3症例 Simultaneous Carotid and Coronary Artery Surgery in Asymptomatic Carotid Artery Stenosis : Report of three cases 小松洋治 ¹ , 中井啓 ¹ , 青木一泰 ¹ , 上村和也 ¹ , 柴田智行 ¹ , 吉澤卓 ¹ , 小林栄喜 ¹ , 小石沢正 ² , 榊原譲 ² , 平松祐司 ² , 能勢忠男 ³ Yoji KOMATSU ¹ , Kei NAKAI ¹ , Kazuyasu AOKI ¹ , Kazuya UEMURA ¹ , Tomoyuki SHIBATA ¹ , Takashi YOSHIZAWA ¹ , Eiki KOBAYASHI ¹ , Tadashi KOISHIZAWA ² , Yuzuru SAKAKIBARA ² , Yuji HIRAMATSU ² , Tadao NOSE ³ ¹筑波記念病院脳神経外科 ²筑波記念病院心臓血管外科 ³筑波大学脳神経外科 ¹Department of Neurosurgery, Tsukuba Memorial Hospital ²Department of Cardiovascular Surgery, Tsukuba Memorial Hospital ³Department of Neurosurgery, Institute of Clinical Medicine, Tsukuba University キーワード： carotid endarterectomy , coronary artery bypass graft , simultaneous surgery , combined surgery Keyword: carotid endarterectomy , coronary artery bypass graft , simultaneous surgery , combined surgery pp.65-69

発行日 2001年1月10日 Published Date 2001/1/10

DOI https://doi.org/10.11477/mf.1436902000

PDF(5768KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

I．はじめに

　頸動脈狭窄病変と冠動脈狭窄病変とは，ともに全身疾患である動脈硬化症の一病像である．したがって，両者はしばしば合併して存在する^{6,13,14,17）}．冠動脈の病変は生命の維持に密接に関連するものであり，また内頸動脈の病変は，中枢神経系機能に関連するもので生存の質に関与する．

　頸動脈狭窄に対する頸動脈内膜切除手術（Carotid endoarterectomy：CEA），また冠動脈狭窄に対する冠動脈バイパス術（Coronary arterybypass graft：CABG）は，各々確立された治療法であるが^24），その適応についてはなお検討が進行中である^2,15,23）．両病変は，お互いに危険因子であり，両者が合併して存在した場合の治療方法については多くの議論がみられる^{1,3,6-8,11,15,18,20）}．この度，冠動脈狭窄症例に合併した無症候性頸動脈狭窄に対して一期的にCEAとCABGを行った3症例を経験したので報告する．

Some patients with coronary artery disease are diagnosed as having additional carotid artery disease. This subset of patients has been identified as a high-risk group for cardiac and cerebral complications fol- lowing surgical intervention. Three patients who underwent combined CEA/CABG for coexistent asymp- tomatic carotid occlusive disease are reported.

Case 1 : A 69-year-old female who suffered chest pain on exertion. Her coronary angiogram showed se- vere stenosis of three vessels. Her carotid angiogram showed 98% stenosis of the right internal carotid artery and poor collateral circulation. The severe stenosis of her carotid artery was considered as a riskfactor for perioperative cerebral stroke. Intraoperatively, CEA preceded the CABG. Postoperative coursewas uneventful.

Case 2: A 64-year-old male. Intermittent claudication was his initial symptom. His coronary angiogramshowed stenosis in three vessels and carotid angiogram showed 75% stenosis in the right carotid artery.Simultaneous CABG and CEA was performed. His postoperative course was uneventful.

Case 3: A 62-year-old male whose ECG indicated ischemic heart disease, although he had no symptoms.His coronary angiogram showed stenosis in three vessels, and 80% stenosis of his right carotid artery wasobserved by carotid angiogram. He underwent simultaneous surgery, and had an uneventful postoperativecourse.

It has been reported that 1.5~8.7% of CABG patients have severe carotid artery stenosis, and periopera-tive cerebral stroke occurrs in 0.9~16%. Simultaneous surgery was successful in our three patients whohad asymptomatic carotid artery stenosis. Using this surgical approach for critical coexistent disease mayminimize the incidence of perioperative cerebrovascular complications in patients undergoing CABG.