総頸動脈閉塞症に対する外科的治療

Abstract

The clinical features of common carotid artery occlusion and principles of its adequate treatment were assessed by analyzing the disease in 7 cases who underwent reconstructive surgery between 1980 and 1985. The occlusions were unilateral in 4 cases and bilateral in 3 cases, and the causes were arteriosclerosis in 2 cases, arteritis in 1 case and aortitis syndrome in 4 cases. The modes of onset were TIA-RIND in 4 cases and minor stroke in 3 cases. Concerning the hemodynamics, the patency of the internal carotid artery via collateral circulation was observed in 8 blood vessels out of a total of 10 occluded blood vessels, and the external carotid artery was patent in 2 cases in whom occlusion extended to the internal carotid artery. The cases of aortitis syndrome were complicated by multiple large vessel occlusions. Operations were performed according to the hemodynamics. These were 9 grafts (8 vein grafts and 1 artificial blood vessel) and 2 transpositions: subclavian-internal carotid artery bypass in 1 case, subclavian-external carotid artery bypass plus STA-MCA bypass in 2 cases, subclavian-common carotid artery bypass in 2 cases and bilateral aortaecommon carotid artery bypass in 1 case.Patency of the bypass was obtained in all the cases. A reoperation was required in 1 case as stenosis of the vein graft occurred in 1.7 years. The therapeutic results were 'good recovery'in 4 cases and 'moderately disabled'in 3 cases, and the symptoms resulting in'moderately disabled'were caused by neurological deficits that existed preoperatively. Improvements were attained of the symptoms due to low perfusions such as amaurosis fugax and orthostatic dizziness. Selection of the operative mode for common carotid artery occlusion should be made according to the hemodynamics by collateral circulation and occlusive lesion complicated, and operative indications were found as subclavian-common carotid artery bypass in the cases of patent common carotid artery, subclavian-internal carotid artery bypass in the cases of patent internal carotid artery and subclavian-external carotid artery bypass plus STA-MCA bypass in the case of patent external carotid artery. Multiple graftings should be made by exposing the aortic arch in aortitis syndrome associated with multiple large blood vessel occlusion.