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連載 合併症のシステマティック・レビュー―適切なInformed Consentのために
（8）頚動脈内膜剝離術
著者： 林健太郎1 永田泉1
所属機関： 1長崎大学脳神経外科
ページ範囲：P.529 - P.539
文献購入ページに移動Ⅰ．はじめに
頚動脈起始部の狭窄は脳血流の低下を来したり，プラークの破綻や血栓形成により脳塞栓症の原因となる．動脈硬化性病変は欧米に多く，頚動脈内膜剝離術（carotid endarterectomy：CEA）は欧米で広く行われてきた．食生活の欧米化や高齢化に伴い，本邦においても患者数は増加してきており，疾患の重要度は増してきている．
手術の有効性を評価するランダム化試験も欧米で行われてきた．North American Symptomatic Carotid Endarterectomy Trial（NASCET）では70％以上の症候性高度狭窄例に対するCEAの有効性が示され60)，European Carotid Surgery Trial（ECST）でも同様の結果が示された21)．Asymptomatic Carotid Atherosclerosis Study（ACAS）やAsymptomatic Carotid Surgery Trial（ACST）では無症候性病変が検討され，高度狭窄例においてCEAの有効性が示された22,29)．近年はcarotid artery stenting（CAS）の有効性を評価するための比較対象となる場合が多いが，CEAの成績は比較的一定している．
脳卒中治療ガイドライン2009では症候性頚動脈高度狭窄に対してはCEAを行うことが推奨され，症候性中等度狭窄および無症候性高度狭窄においても推奨されている78)．症候性軽度狭窄あるいは無症候性中等度狭窄ないし軽度狭窄においては，プラークが不安定であったり，潰瘍が認められる場合にはCEAを考慮してもよいが，科学的根拠はないとされている．
このようにCEAの有効性は認められており69)，日本脳神経外科学会のデータでは2011年に3,776件施行されている．CEAは脳卒中発作を予防するための手術であるため，合併症を低く抑える必要があり，手術リスクは症候性病変では6％，無症候性病変では3％以下の場合に有効とされている．よって，手術および周術期管理に熟達した術者と施設において行われるべきである．本稿ではCEAの手術説明の一助となることを目的に，CEAの合併症に関する論文をレビューした．
頚動脈起始部の狭窄は脳血流の低下を来したり，プラークの破綻や血栓形成により脳塞栓症の原因となる．動脈硬化性病変は欧米に多く，頚動脈内膜剝離術（carotid endarterectomy：CEA）は欧米で広く行われてきた．食生活の欧米化や高齢化に伴い，本邦においても患者数は増加してきており，疾患の重要度は増してきている．
手術の有効性を評価するランダム化試験も欧米で行われてきた．North American Symptomatic Carotid Endarterectomy Trial（NASCET）では70％以上の症候性高度狭窄例に対するCEAの有効性が示され60)，European Carotid Surgery Trial（ECST）でも同様の結果が示された21)．Asymptomatic Carotid Atherosclerosis Study（ACAS）やAsymptomatic Carotid Surgery Trial（ACST）では無症候性病変が検討され，高度狭窄例においてCEAの有効性が示された22,29)．近年はcarotid artery stenting（CAS）の有効性を評価するための比較対象となる場合が多いが，CEAの成績は比較的一定している．
脳卒中治療ガイドライン2009では症候性頚動脈高度狭窄に対してはCEAを行うことが推奨され，症候性中等度狭窄および無症候性高度狭窄においても推奨されている78)．症候性軽度狭窄あるいは無症候性中等度狭窄ないし軽度狭窄においては，プラークが不安定であったり，潰瘍が認められる場合にはCEAを考慮してもよいが，科学的根拠はないとされている．
このようにCEAの有効性は認められており69)，日本脳神経外科学会のデータでは2011年に3,776件施行されている．CEAは脳卒中発作を予防するための手術であるため，合併症を低く抑える必要があり，手術リスクは症候性病変では6％，無症候性病変では3％以下の場合に有効とされている．よって，手術および周術期管理に熟達した術者と施設において行われるべきである．本稿ではCEAの手術説明の一助となることを目的に，CEAの合併症に関する論文をレビューした．
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