頸部頸動脈に閉塞性病変を有する症例の局所脳血流量 (rCBF) の検討

抄録

The previous studies have shown that the reduction of cerebral blood flow (CBF) is seen in patients with stenotic lesions of the cervical carotid artery exceeding 70% or more. However, these reports have not mentioned on the reduction of CBF in patients with ulcerated plaques. The purpose of this study is to investigate changes in CBF associated with occlusive lesions at the cervical carotid artery including the ulcerated plaques. Regional CBFs were determined from clearance-curves obtained from the extracranial detection of intraarterially or intravenously injected ¹³³Xenon. Results were divided in two: localized and generalized (mean CBF) abnormalities.
Five cases with the carotid stenosis (mild stenosis 2, mild stenosis+ulcer 2, severe stenosis+ulcer 1) and 6 cases with the complete carotid occlusions (including bilateral carotid occlusion 1, contralateral carotid stenosis 2) were studied. The result of CBF measurement showed abnormalities in all cases. The mean CBF was abnormally low in 8 cases and the CBF was reduced locally in 7 cases. In three of 5 cases with mild stenosis (including 2 cases of mild stenosis with ulcer), a significant local reduction was noted. In remaining two, the reduction was general, but the reduction was thought to be due to additional intracranial arterial lesions (stenosis at the siphon and recanalized MCA stenosis respectively). In 5 of 6 cases with the complete carotid occlusion, the general reduction of CBF was observed.
Thus, CBF change, either localized or generalized, might be related to the cause of ischemic cerebrovascular disease, because pure ulcerations without stenosis of high degree would produce localized reduction of CBF, if it occurs. The measurements of CBF are of value in determining a surgical indication, especially in patients with multiple extra and intracranial arterial lesions.