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段階的頚動脈血管形成術の過灌流症候群予防効果についての検討

早川, 幹人 筑波大学 DOI:10.15068/0002000680

2021.07.26

概要

頚部頚動脈がアテローム性動脈硬化により狭窄を呈する頚動脈狭窄症は、虚血性脳血管障害(脳梗塞、一過性脳虚血発作 transient ischemic attack [TIA])の原因となる疾患である。65 歳以上の一般人口において、狭窄率 50%以上の無症候性頚動脈狭窄症は、男性で 7%、女性で 5%に認めるとされ 1、急性期虚血性脳血管障害連続例の 11%が狭窄率 50%以上の頚動脈狭窄症を有したとのわが国の単施設報告もあり 2、脳卒中診療において重要な位置を占めている。頚動脈狭窄症における虚血性脳血管障害の発症機序は、プラーク内容物や血栓が末梢脳血管に飛散する動脈原性塞栓機序(artery-to-artery embolism)と、狭窄遠位の脳血流不全による血行力学的機序(および双方の併存)に大別される。

抗血小板療法を含む内科治療による局所の血栓形成抑制・プラーク安定化・狭窄進展抑制に加え、血行再建療法(頚動脈内膜剥離術 carotid endarterectomy [CEA]、頚動脈ステント留置術 carotid artery stenting [CAS])による狭窄(および塞栓源)の解除・脳血流不全の改善が直接的かつ効果的な予防治療となるが、CEA は、全身麻酔下に内頚動脈狭窄症の原因となるプラークを切除する外科的治療手技である一方、CAS は、主に局所麻酔下に、遠位塞栓防止デバイスを併用しながら血管形成術( percutaneous transluminal angioplasty [PTA])を行って狭窄部(プラーク)を押し広げ、ステントを留置する血管内治療手技である、という大きな違いがある。

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