頭蓋内外に閉塞性病変を有するいわゆる tandem lesion に対する外科的療法の検討

抄録

Eleven patients with occlusive intra- and extra-cranial lesions in the same cerebrovascular system (tandem lesions) were treated by a combination of carotid endarterectomy(CEA) and extraintracranial bypass(EC/IC bypass). In this paper, we report on the therapeutic principles involved with these patients and a newly developed external shunt system used during CEA for preservation of blood flow in the external carotid artery when this procedure was preceded by an EC/IC bypass.
The eleven parients were divided into three groups based on the findings of preoperative cerebral angiography: Group A with a primary lesion in the cervical carotid artery(5 patients), Group B with intra- and extra-cranial lesions of similar degrees (3 patients), and Group C with a primary lesion in the intracranial cerebral artery (3 patients). The CEA preceded the EC/IC bypass in Groups A and B, but the EC/IC bypass was performed first in Group C. Three patients in Group A were subclassified as Group A′ because of specific carotid lesions. In Group A′, one patient with an occlusive cervical carotid lesion extending to the inferior margin of C₁ underwent an EC/IC bypass before the CEA, but the other two, with an occlusive lesion in the cervical internal carotid artery and narrowing of the external carotid artery, initially underwent a CEA of the external carotid artery. During the CEA in the four parients in whom the EC/IC bypass was performed first, the external shunt system we developed was used along with the conventional internal shunt system to preserve the blood flow in the external as well as internal artery system. Good surgical results were obtained, and the postoperative courses were favorable.