CAJ | 학술논문

目的:探讨双侧颈动脉粥样硬化性狭窄患者的手术适应证、时机和策略.方法:1987年2月至2007年12月共收治74例双侧颈动脉粥样硬化性狭窄患者,其中34例患者症状限于一侧,均施行了一侧颈动脉内膜切除(CEA),其中8例对侧因狭窄>70%或粥样硬化斑块不稳定而行CEA或支架成形(CAS).38例双侧均有症状,15例双侧先后施行CEA;3例一侧行CEA,对侧行CAS;20例仅行单侧CEA.另外2例双侧无症状,均因狭窄>70%而行单侧CEA,其中1例还行对侧CAS.结果:本组74例患者共行93侧CEA,68例术后顺利,2例神经功能障碍加重,2例出现心肌缺血,1例脑出血,1例声音嘶哑.67例患者平均随访4.9年,63例无与术侧颈动脉相关的脑缺血事件发生.结论:颈动脉粥样硬化性狭窄患者只要指征明确,无论对侧颈动脉正常、狭窄甚至闭塞,均应施行CEA.双侧狭窄患者的治疗时机和策略因人而异.CEA术中主要依据电生理监测结果决定是否采用转流.
목적:탐토쌍측경동맥죽양경화성협착환자적수술괄응증、시궤화책략.방법:1987년2월지2007년12월공수치74례쌍측경동맥죽양경화성협착환자,기중34례환자증상한우일측,균시행료일측경동맥내막절제(CEA),기중8례대측인협착>70%혹죽양경화반괴불은정이행CEA혹지가성형(CAS).38례쌍측균유증상,15례쌍측선후시행CEA;3례일측행CEA,대측행CAS;20례부행단측CEA.령외2례쌍측무증상,균인협착>70%이행단측CEA,기중1례환행대측CAS.결과:본조74례환자공행93측CEA,68례술후순리,2례신경공능장애가중,2례출현심기결혈,1례뇌출혈,1례성음시아.67례환자평균수방4.9년,63례무여술측경동맥상관적뇌결혈사건발생.결론:경동맥죽양경화성협착환자지요지정명학,무론대측경동맥정상、협착심지폐새,균응시행CEA.쌍측협착환자적치료시궤화책략인인이이.CEA술중주요의거전생리감측결과결정시부채용전류.
Objective To evaluate the indication, time and strategy of surgery for patients with bilateral carotid atherosclerotic stenosis. Methods Seventy-four patients with bilateral carotid atherosclecrotic stenosis were admitted to our hospital from February 1987 to December 2007. In 34 patients who presented with unilateral symptoms and underwent ipsilateral carotid endarterectomy (CEA), contralateral CEA or carotid artery stenting (CAS) was performed in 8 because of severe stenosis ( >70% ) or unstable plaque. Thirty-eight patients presented with bilateral symptoms. Among them, 15 underwent CEA on both sides, 3 were performed CEA on one side and CAS on the other side, while 20 underwent unilateral CEA only. In 2 asymptomatic patients, CEA was also performed. Results Ninety-three cases of CEA were performed in 74 patients. Sixty-eight patients were uneventful after operation. Neurological deficits deteriorated in 2 patients. Four patients developed cardiac iscbemia, cerebral hemorrhage and hoarseness respectively. Sixty-seven patients were followed-up for 4.9 years. No cerebral iscbemia relevant to operated carotid artery developed in 63 patients. Conclusions If the indication is obvious, CEA should be performed no matter how contralateral carotid artery is. The strategy of therapy is individual. Whether using shunt depends on intra-operative monitoring.