内頸動脈閉塞性疾患の臨床像とその治療成績

Clinical features and therapeutic outcome in carotid artery stenosis

　Magnetic resonance angiography （MRA）あるいは脳血管撮影で内頸動脈狭窄症ないし閉塞症と診断された6例を経験した。男性5例，女性1例で，平均62.3歳（50〜75歳）であった。2例は糖尿病，2例は高血圧であり，1例は両者を合併していた。初診時5例は一過性黒内障の既往があり，2例は視力低下を自覚していた。螢光眼底撮影では全症例で腕—網膜循環時間の遅延が認められた。6例のうち5例は90％以上の内頸動脈狭窄症であり，1例は両側内頸動脈低形成であった。1例に頸動脈内膜剥離術，3例に浅側頭動脈—中大脳動脈吻合術が施行された。血管新生緑内障の3眼には汎網膜光凝固を施行し，うち2眼にはトラベクレクトミーを施行した。MRAは内頸動脈狭窄病変を描出でき，内頸動脈閉塞性疾患の非侵襲的診断法として有用であった。

We reviewed six cases of carotid artery stenosis. The diagnosis was initially confirmed by magnetic resonance angiography (MRA) or carotid arteriography. The present series comprised five males and one female. The ages ranged from 50 to 75 years, average 62.3 years. Two patients had diabetes mellitus and two had systemic hypertention. One of them had both diabetes and hypertension. Five patients had history of amaurosis fugax and two showed decreased vision at the initial presentation. Fluorescein angiography showed delayed arm -to-retina circulation time in all six patients. Five had stenosis over 90% of the ipsilateral internal carotid artery. One had bilateral carotid artery hypoplasia. One patient was treated by carotid endarterectomy and three received anastomosis between superficial temporal artery and middle cerebral artery. Three eyes with neovascular glaucoma were treated by panretinal photocoagulation. Two eyes were additionally treated by trabeculectomy.