BRAIN and NERVE－神経研究の進歩65巻1号

2013年01月発行

症例報告

頸動脈内膜剝離術後再狭窄例における術前および再狭窄時の頸動脈MRI所見（3例報告)

著者： 遠藤英樹¹ 上山憲司¹ 高平一樹¹ 荻野達也¹ 髙田英和¹ 片岡丈人¹ 瓢子敏夫¹ 中川原譲二¹ 尾野英俊² 中村博彦¹

所属機関： ¹中村記念病院脳神経外科 ²中村記念病院放射線科

ページ範囲：P.93 - P.97

文献概要

はじめに

　頸部頸動脈狭窄症の評価において，頸動脈MRI（magnetic resonance imaging）の有用性が多数報告されている^1-4)。しかしながら，術後再狭窄例に関する報告はない。頸動脈内膜剝離術（carotid endarterectomy：CEA）後再狭窄に対して頸動脈ステント留置術（carotid artery stenting：CAS）を施行した3症例において，術前病変および再狭窄病変の頸動脈MRI所見（信号強度パターン，形態）を評価・検討したので報告する。

参考文献

1) 遠藤英樹, 吉田和道, 黒崎義隆, 定政信猛, 鳴海　治, 他: Screening Black-blood MRIによるプラーク内出血の検出. No Shinkei Geka 37: 249-253, 2009

2) Honda M, Kitagawa N, Tsutsumi K, Nagata I, Morikawa M, et al: High-resolution magnetic resonance imaging for detection of carotid plaques. Neurosurgery 58: 338-346, 2006

3) Yoshida K, Narumi O, Chin M, Inoue K, Tabuchi T, et al: Characterization of carotid atherosclerosis and detection of soft plaque with use of black-blood MR imaging. AJNR Am J Neuroradiol 29: 868-874, 2008

4) Yuan C, Mitsumori LM, Beach KW, Maravilla KR: Carotid atherosclerotic plaque: noninvasive MR characterization and identification of vulnerable lesions. Radiology 221: 285-299, 2001

5) Frericks H, Kievit J, van Baalen JM, van Bockel JH: Carotid recurrent stenosis and risk of ipsilateral stroke: a systematic review of the literature. Stroke 29: 244-250, 1998

6) Hellings WE, Moll FL, de Vries JP, de Bruin P, de Kleijn DP, et al: Histological characterization of restenotic carotid plaques in relation to recurrence interval and clinical presentation: a cohort study. Stroke 39: 1029-1032, 2008

7) Makihara N, Toyoda K, Uda K, Inoue T, Gotoh S, et al: Characteristic sonographic findings of early restenosis after carotid endarterectomy. J Ultrasound Med 27: 1345-1352, 2008

8) 井上勝美: PTCA・ステントの病理カラーアトラス. 医学書院, 東京, 2002, pp8-13

9) van Lammeren GW, Peeters W, de Vries JP, de Kleijn DP, De Borst GJ, et al: Restenosis after carotid surgery: the importance of clinical presentation and preoperative timing. Stroke 42: 965-971, 2011

10) Hellings WE, Moll FL, De Vries JP, Ackerstaff RG, Seldenrijk KA, et al: Atherosclerotic plaque composition and occurrence of restenosis after carotid endarterectomy. JAMA 299: 547-554, 2008

11) Altaf N, MacSweeney ST, Gladman J, Auer DP: Carotid intraplaque hemorrhage predicts recurrent symptoms in patients with high-grade carotid stenosis. Stroke 38: 1633-1635, 2007

12) Altaf N, Daniels L, Morgan PS, Auer D, Macsweeney ST, et al: Detection of intraplaque hemorrhage by magnetic resonance imaging in symptomatic patients with mild to moderate carotid stenosis predicts recurrent neurological events. J Vasc Surg 47: 337-342, 2008

13) Kurosaki Y, Yoshida K, Endo H, Chin M, Yamagata S: Association between carotid atherosclerosis plaque with high signal intensity on T1-weighted imaging and subsequent ipsilateral ischemic events. Neurosurgery 68: 62-67, 2011

14) Takaya N, Yuan C, Chu B, Saam T, Underhill H, et al: Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI-initial results. Stroke 37: 818-823, 2006

15) Yamada N, Higashi M, Otsubo R, Sakuma T, Oyama N, et al: Association between signal hyperintensity on T1-weighted MR imaging of carotid plaques and ipsilateral ischemic events. AJNR Am J Neuroradiol 28: 287-292, 2007

16) Takaya N, Yuan C, Chu B, Saam T, Polissar NL, et al: Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaque: a high-resolution magnetic resonance imaging study. Circulation 31: 2768-2775, 2005