Neurological Surgery 脳神経外科36巻2号

2008年02月発行

総説

頸部頸動脈狭窄症に対する血管内手術

著者： 大田元¹ 竹島秀雄¹

所属機関： ¹宮崎大学医学部臨床神経科学講座脳神経外科学分野

ページ範囲：P.107 - P.118

Ⅰ．はじめに

　近年，食生活や生活様式の欧米化に伴いわが国でも動脈硬化性頸動脈狭窄症が増加している．高度の頸動脈狭窄症はartery-to-artery embolismやhemodynamic strokeなどを引き起こすため，適切な診断，治療が望まれる．頸動脈内膜剥離術（carotid endarterectomy；CEA）は，頸動脈狭窄症による脳梗塞の予防目的で行われてきた外科的治療法で，これまでに欧米で行われたNASCET（North American Symptomatic Carotid Endarterectomy Trial）^5,7)，ECST（Europian Carotid Surgery Trial）^39,44,49)，VA309（Veterans Affairs Cooperative Studies Trial 309）³⁶⁾，ACAS（Asymptomatic Carotid Atherosclerosis Study）¹⁹⁾などに代表される多施設共同研究の結果からも外科的治療のgold standardとして確立されている．一方で1980年代より，頸動脈狭窄症に対する血管内治療が報告されはじめた^10,65)．当初はバルーンカテーテルによる経皮的血管形成術（percutaneous transluminal angioplasty；PTA）のみであったが，1990年代に入りステント留置術（carotid artery stenting；CAS）へと発展し，さらにdistal protection devices（DPD）の開発でより安全性が向上したことで急速に普及し，わが国でも本年度中にも保険認可がおりそうな最終段階にきている．本稿では頸動脈狭窄症に対する血管内手術について，その歴史，適応，実際の手技，今後の展望と問題点について述べる．

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