抄録
Carotid endarterectomy was performed on 36 patients with stenosis of extra-cranial carotid artery due to atherosclerosis. This study was undertaken to determine criteria for this procedure based on clinical symptoms, angiographical findings versus post-operative pathological findings and post-operative clinical courses. This series includes 7 cases of RIND'(s) and 29 cases of completed stroke. These cases were divided into four categories according to residual lumen of stenotic lesion demonstrated by arteriograms of 31 cases. Grade 1 : Less than 2 mm in diameter; Grade 2: Smaller in diameter than carotid artery; Grade 3: Greater in diameter than carotid artery, smaller than common carotid artery; and Grade 4: Greater in diameter than common carotid artery. Pathological findings were divided into four categories: ulcer, mural thrombus, hemorrhage and atherosclerosis. Angiographical findings were compared with pathological findings. Three cases were classified as Grade 1 and 17 cases were classified as Grade 2. Among these, 4 cases showed ulcer, 3 cases mural thrombus, 2 cases hemorrhage, and 8 cases atherosclerosis. Seven cases were classified as Grade 3. Among these 4 cases showed ulcer and 3 cases mural thrombus. Four cases were classified as Grade 4. Among these one case showed Mural thrombus and one case atherosclerosis. Among cases which had more than four irregularities in the arteriograms, 4 cases had mural thrombus, 5 cases ulcer and 5 cases atherosclerosis. The number of irregularities were related with severeness of abnormal findings in pathology. Among cases in which contrast medium remained more than 5 seconds after vanishing of laminal flow of common carotid artery, 6 cases had ulcer, 5 cases mural thrombus and 3 cases atherosclerosis. Of all operated cases 25 patients had revealed no worsening of clinical findings during a follow-up period from 5 months to 3 years and 2 months.
From our data described above, the authors propose the following surgical indications of carotid endarterectomy: Grade 1 cases definitely should be operated. Grade 2 cases may be good indication. Grade 3 and Grade 4 cases are relatively suitable for operation, if they show “irregularities” and “long resting time of contrast medium.”
