両側総頸動脈全長にわたり奇異な狭窄を呈した1症例

Abstract

We report a case of severe stenosis of bilateral external carotid arteries. The patient was a 58-year-old male who had noticed repeated blackouts, nausea and drop attack-like weakeness of extremities resulting in immobility for several hours. Marked bruit was heard over the bilateral carotid arteries. The angiography revealed multiple ulcer formation, wall irregularity and peculiar stenosis in the entire course of the bilateral common carotid arteries from their origin to bifurcation, sparing the extra- and intracranial internal carotid artery. Collateral flow through the anterior communicating artery was abundant and he well tolerated Matas test, but the collaterals from vertebrobasilar system were poor and he lapsed into unconsciousness in 5 seconds by Alcock test. He underwent subclavian-dacron graft-internal carotid bypass. A 6mm dacron graft was used. An end-to-side anastomosis was done first on the subclavian artery and then on the internal carotid artery. The carotid bifurcation was resected for the histological examination, which revealed that this rare condition was caused by atherosclerosis selectively affecting the common carotid artery. The operative result was successful, and the postoperative angiography revealed good graft patency. He has experienced no further attack and has been reinstated in his former office. We discuss the pathogenesis and operative procedures for this condition.