Profound deficitを呈した急性期頸部内頸動脈閉塞に対する血栓内膜剥離術

Abstract

Emergency carotid endarterectomy (CEA) was performed in 10 patients with proximal internal carotid artery occlusion associated with profound neurological deficits. All patients visited our clinic within 5 hours from the onset, and flow of the IC was restored 4.9 hours after the onset on average. Of the 10 patients, the outcome was excellent in 3, good in 4, severe disability in 2, and 1 died. For these patients, prevention of distal embolism after CEA is most important.According to the intraoperative findings, namely, whether or not back-flow from the distal IC was demonstrated by arteriotomy of the IC distal to the occlusion, and whether or not clotting existed in the distal IC, the 10 patients were divided into 3 groups.Group A (3 cases): Back-flow from the distal IC was demonstrated and clotting of the distal IC was not demonstrated.Group B (2 cases): Both back-flow from the distal IC and clotting of the distal IC were demonstrated.Group C (5 cases): Back-flow from the distal IC was not demonstrated because of packed clotting in the distal IC.In group A, restoration of the flow will be established without distal embolism by not only CEA but also fibrinolysis followed by percutaneous transluminal angioplasty (PTA). For group B and group C, clotting of the distal IC shoud be removed by forceps or aspiration through the distal tube of the internal shunt during CEA to prevent the distal embolism. At present, it is best to use CEA for patients with proximal IC occlusion to prevent the distal embolism, because it is impossible to know whether or not clotting exsists in the distal IC.