近年、頚部内頚動脈狭窄症がわが国でも急速に増加しつつあります。本症では、脳梗塞や一過性脳虚血発作、一過性黒内障を予防するために、抗血小板剤などによる内科治療が無効の場合あるいは無効と考えられる場合、頚動脈内膜剥離術（CEA）あるいは頚動脈ステント留置術（CAS）が必要となります。それぞれ一長一短の治療法ではありますが、最近巷で流行しているEBMの概念をもとに繰り広げられてきた「CEAとCASのどっちが優れているのか？」といった議論には同調できません。現時点では、両者の長所を最大限に生かした総合的な治療戦略がそれぞれの患者さんに最も大きな恩恵をもたらすことができると信じています。その信念のもとに立ち上げた「越中八索」プロジェクトの第一弾を当科の秋岡直樹先生が論文として公表してくれました。約3年間における104件のCEA・CASの治療成績です。今後もさらに治療成績を向上させることで、われわれの「越中八索」の意義を明らかにしていきたいと思います。
秋岡直樹、柏崎大奈、高 正圭、桑山直也、田中耕太郎、黒田 敏：
頚動脈狭窄症に対する包括的治療戦略ー「越中八策」の初期成績。
脳外 44:31-38, 2016
http://www.ncbi.nlm.nih.gov/pubmed/26771094
A Voyage to Depth of Neuroscience Vol. 24
Akioka N, Kashiwazaki D, Koh M, Kuwayama N, Tanaka K, Kuroda S.
Comprehensive Hybrid Strategy for Carotid Artery Stenosis with 8 Rules “Toyama Carotid 8”
No Shinkei Geka. 2016 Jan;44(1):31-8.
Abstract:
In this paper, the preliminary results of carotid endarterectomy(CEA)and carotid artery stenting(CAS)for patients with carotid artery stenosis based on the 8 Rules “Toyama Carotid 8” are reported. This study included 104 patients who underwent CEA or CAS for carotid artery stenosis between March 2012 and January 2015. Toyama 8 Rules primarily recommend CEA and CAS for symptomatic and asymptomatic lesions, respectively. However, crossover of therapeutic options can be performed in patients at high surgical risk associated with CEA or CAS. Monitoring of platelet function is important prior to CAS. Internal shunting and near infrared spectroscopy monitoring are essential in CEA. Temporary cardiac pacing is essential in CAS. The choice of protection device and stent depends on the results of MR plaque imaging. Cerebral blood flow measurement is mandatory before and after CEA/CAS. Fifty-two CEAs and 52 CASs were performed for 55 symptomatic and 49 asymptomatic lesions. Crossover of therapeutic options was performed in 10(18%)of 55 symptomatic lesions and 7(14%)of 49 asymptomatic lesions. The 30-day morbidity rate was 1.9% in CEA and 1.9% in CAS. Postoperative diffusion-weighted magnetic resonance imaging showed fresh ischemic lesions in 5 patients who underwent CEA(10%)and 9 who underwent CAS(17%). Hyperperfusion syndrome occurred in one patient(1.0%). A management protocol for carotid artery stenosis needs to be established in hospitals to allow sharing of information and improvement in the short-term results of CEA / CAS for carotid artery stenosis. Further studies are warranted to evaluate the long-term outcome.
