本邦における頸部頸動脈狭窄症治療の現況-全国アンケート調査より-

Abstract

We report the results of a nationwide questionnaire investigating the current therapeutic strategy for carotid artery stenosis in Japan sent to 1102 neurosurgical institutes. Of them, 445 (40.4%) replied. The mean number of carotid endarterectomies (CEAs) performed in 1997 was 1.9. CEAs for both symptomatic and asymptomatic carotid stenosis are increasing in number, but remain few compared with North America or Europe. Endovascular surgery for carotid artery stenosis is still uncommon in Japan. More than half of Japanese neurosurgeons considered that CEA is necessary for asymptomatic carotid artery stenosis of more than 60% if the patient is less than 70 years old and in good general condition. About 90% of institutes used intraoperative monitoring such as electroencephalography, stump pressure and somatosensory evoked potentials. The operative microscope was used in 71% of institutes. Intraoperative shunting was used for all cases in 40% of institutes, for selected cases in 32% and for no cases in 16%. Tacking suture was used in all cases in 41% of institutes.It is somewhat difficult to do CEA for Japanese patients, because Japanese carotid artery stenosis has a tendency to have a higher position of the carotid bifurcation and relatively harder plaque than in Western patients. A nationwide prospective study will evaluate the optimum therapeutic strategy.