2015 年 28 巻 3 号 p. 146-149
Cervical carotid artery evaluation is central to the treatment of carotid stenosis, and is usually performed using MRI, magnetic resonance angiography (MRA), 3-dimensional CT angiography (3D-TA), and carotid ultrasonography. Carotid ultrasonography is a non-invasive, easily repeated method that can also allow real-time intraoperative monitoring. We can accurately determine the location of a carotid lesion using ultrasound navigation. The positions of the cervical vertebrae from C3 to C7 are confirmed before and after carotid evaluation. Using this system, we place marks on real-time images that act as guides to lesion location. We defined this technique as the “ vertebral level measurement method”. We evaluated whether the technique was effective in a stroke patient with a carotid lesion and an allergy to iodine. The case involved a 69-year-old man with cerebral infarction. Carotid ultrasonography revealed a severe and vulnerable stenotic plaque in the right cervical carotid artery. Cerebral angiography or percutaneous carotid angioplasty could not be performed due to the iodine allergy, but carotid endarterectomy (CEA) needed to be performed. Using the “ vertebral level measurement method”, we performed an evaluation similar to preoperative angiography. CEA was then successfully completed without contrast examination. This method appears extremely helpful.