心虚血を伴った脳虚血患者に対する血行再建術

Revascularization for Simultaneous Carotid and Coronary Ischemia

I．はじめに

　脳虚血症状を呈する患者のなかには，狭心症発作などの心虚血を合併するものもある．このような症例では，脳血行だけでなく冠血行の再建も必要な場合がある．従来，coronary artery bypass grafting（CABG）をcarotidendarterectomy（CEA）と併せて行うことはあったが，extracranial-intracranial（EC-IC）bypassと併用した報告はほとんどない^1,4,7,12）．

　このたびわれわれは，EC-IC bypassとCABGの両者が必要と考えられる症例では，いずれを優先して行うべきかを検討した．さらに，minor strokeとunstableanginaを合併する症例，およびRINDとmyocardiacinfarctionを合併する症例の2例に対し，実際にまずEGIC bypass，次いでCABGの順にtwo-stageに分けて脳・心の血行再建術を施行し，良好な結果を得たので報告する．

Some of the patients who suffer from cerebral ische-mia may at the same time have coronary insufficiency. For such cases, not only extracranial-intracranial (EC-IC) bypass but also cardiac revascularization is consi-dered to be necessary. One-stage surgery of both carotid endarterectomy and coronary artery bypass grafting (CABG) has not infrequently been published. However, the combination of EC-IC bypass and CABG is rarely reported in the literature.

The indication of EC-IC bypass and/or CABG for such patients above stated has been searched for.