頸部内頸動脈高度狭窄によるprogressing stroke に対してemergency carotid endarterectomyを行った8例

Abstract

We report 8 patients with progressing stroke who underwent emergency carotid endarterectomy (CEA) successfully.There were 7 males and 1 female, with a mean age of 66 years (range 62 to 74 years). The time from the onset of neurological deficit to the CEA ranged from 2 to 36 hours.Preoperative clinical status included 4 patients with severe deficit, 3 with moderate deficit and 1 with mild deficit according to Walters' grading of 5 categories (intact, mild deficit, moderate deficit, severe deficit, death). Carotid bruit was heard in only 2 patients.Angiographic findings revealed that all patients had severe stenosis (>93%) of the cervical internal carotid artery (ICA) with delay in flow (one of whom had a residual stenosis after recanalization of ICA-occlusion treated with intra-arterial infusion of urokinase), 5 with occlusion of the intracranial arteries caused by artery-to-artery embolism, 4 with cross-filling from the contralateral carotid artery through the anterior communicating artery and 1 with an intraluminal filling defect of carotid artery due to a floating thrombus.On the preoperative CT scanning, none of 4 patients admitted within 5 hours of onset had fresh lesions and all of 4 patients admitted after 5 hours of the onset had small fresh infarction, none of which were enhanced after the administration of contrast material.The postoperative course was excellent in all patients, and the postoperative CT scan did not demonstrate any new lesions in 7 patients but disclosed an asymptomatic small watershed infarction in 1 patient.We discuss indications for emergency carotid endarterectomy for progressing stroke.