Near occlusionを呈する頸部頸動脈狭窄病変に対するCEA  [in Japanese] CEA for the Carotid Stenosis Cases with Near Occlusion  [in Japanese]

Near occlusion of the carotid artery has been defined as very severe stenosis at the site of the residual lumen, delayed flow of angiographic contrast material, and reduced arterial caliber secondary to artery collapse. The management of a patient with an atherosclerotic near occlusion of the carotid artery remains controversial. We basically treat patients with carotid near occlusion with carotid endarterectomy (CEA). In the present study, we investigated the surgical indications for the lesion, benefits of CEA, and intraoperative technique and devices. Seven male patients with near occlusion (55-69 years old) were recently treated with CEA during a 4-year period in our institute. Preoperative angiogram and B-mode Doppler did not demonstrate the distal end of the stenotic lesion clearly. All the patients had symptomatic carotid stenotic lesions. We applied the intravascular ultrasound (IVUS) catheter extravascularly to the cervical carotid arteries to obtain intraoperative ultrasound images during CEA not only to expose the lesions sufficiently but also to place the shunt system safely. Extravascular application of IVUS catheter before making arteriotomies correctly depicted the distal ends of the internal carotid artery (ICA) stenotic lesions as a thin layer of vascular wall. Postoperative angiography or MRA demonstrated sufficient intracranial blood flow in the patients with near occlusion treated with CEA. Although the patients did not have any perioperative surgical complications in the present series, we should always pay attention to prevent postoperative hyperperfusion syndrome in cases of carotid near occlusion. We consider CEA beneficial for near occlusion with a low complication rate, which was not more dangerous than in CEA for usual patients with carotid stenotic lesions.