頸部頸動脈閉塞性病変に対するT-字型シャントを用いた頸動脈血栓内膜摘除術

抄録

We have introduced a newly devised shunt system for carotid endarterectomy (CEA) in patients who have relatively high cervical lesions. Among 155 patients, 170 CEAs were performed using this shunt system, and mortality and morbidity were 0% and 2.4%, respectively. Bilateral carotid endarterectomy were performed in the 15 patients without complications. Additionally 5 patients showed contralateral carotid occlusion with ipsilateral severe stenosis, two of whom had staged operations; STA-MCA anastomosis was performed for the occluded side and CEA for stenotic lesion. Their outcomes were also good. The effects of angioplasty on carotid stenotic lesion was intraoperatively investigated by inflation of a balloon catheter 3 or 4 times with 2.5-3.5 atmospheric pressure. Only 3 of 12 stenotic lesions were macroscopically dilated with intravascular exudation of atheroma and laceration of the intima.
We have demonstrated CEA can be safely and easily performed with a routine application of our shunt system even in multiple occlusive lesions.