無症候性頸動脈狭窄症に対する血行再建術-Stentingの現状をCEAと対比して-

Abstract

Several large randomized multicenter trials have demonstrated the beneficial effects of carotid endarterectomy (CEA) for prevention of strokes in patients with severe symptomatic or asymptomatic carotid artery stenosis. On the other hand, endovascular treatments are rapidly evolving as alternatives to CEA, but indication for endovascular treatment remain uncertain and long-term results have not yet been established. We experienced 59 consecutive patients with asymptomatic carotid artery stenosis treated with CEA in 5 recent years, and 14 patients with asymptomatic carotid artery stenosis treated with stenting since 1997. One minor stroke (1.7%, hemiparesis and aphasia) and 1 transient neurological event occurred after CEA, and one major stroke (7.1%, hemiplegia) occurred during stenting by distal embolic occlusion of MCA and ACA. There were no neurological events after either CEA or stenting, but distal embolic signals were detected in all patients with TCD during stenting, and embolic lesions were detected in more than half the patients with MRI/DWI after stenting.We consider that cerebral protection by means of balloon is mandatory to eliminate embolic complication in the endovascular treatment of carotid artery stenosis. Stenting for asymptomatic carotid artery stenosis can now be indicated only for surgically high-risk patients who are very old, have severe heart or pulmonary disease, contraindication to general anesthesia, high-positioned stenosis, restenosis after CEA or PTA, or radiation-induced stenosis.