高位病変CEAに対する3D-CTA＋2D-CT合成画像支援の有用性と限界

Abstract

Carotid endarterectomy (CEA) is a standard treatment for internal carotid artery (ICA) stenosis. The level of carotid bifurcation of Japanese is reportedly higher than that of Europeans. Therefore, it is somewhat difficult to develop an operative field on the distal side of ICA stenosis. We conducted of this study to clarify the usefulness and feasibility of 3D-CTA and 2D-CT imaging using 16-raw CT for CEA with a high-positon ICA stenosis. Between 2006 and 2010, 51 CEAs for 50 consecutive patients with ICA stenosis were performed in our institutes. Thirteen of these were high-position ICA stenosis. For CEA with high-position ICA stenosis, we tried to visualize the anatomical structures of the retromandibular space using 3D-CTA with 2D-CT, which is perpendicular to the operative approach, at the three depths of the sternocleidomastoid muscle, jugular vein, and carotid bifurcation. In all 13 patients, the parotid gland, jugular vein, and plaque position could be visualized. However, in one of the 13 patients, the distal side of the ICA stenosis could not be visualized, and we unexpectedly needed to cut the occipital artery, and in six of the 13 patients, the common facial vein could not be observed. In the last 10 patients, the MRI diffusion image revealed no additional ischemic lesion. In our series, no persistent morbidity or mortality was observed. Preoperative simulation using 3D-CTA+2D-CT might be useful for CEA with high-position ICA stenosis, despite the limitation of the visualization of the common facial vein.