Suga Yasunori, Ogasawara Kuniaki, Saito Hideo, Kobayashi Masakazu, Inoue Takashi, Kondo Ryuji, Tsuboi Junichi, Ogawa Akira
Department of Neurosurgery, Iwate Medical University, 19-1 Utimaru, Morioka, Iwate 020-8505, Japan.
Brain Nerve. 2007 Dec;59(12):1377-81.
A 75-year-old man, who had undergone coronary artery bypass graft and repair for abdominal aortic aneurysm, suffered from angina pectoris due to severe aortic valve stenosis complicated with asymptomatic bilateral cervical internal carotid artery stenoses. Brain perfusion imaging revealed reduced cerebral blood flow and cerebrovascular reactivity to acetazolamide in the bilateral cerebral hemispheres. First, the patient underwent left carotid endarterectomy, and the postoperative course was uneventful. Postoperative brain perfusion imaging showed improvement of cerebrovascular reactivity to acetazolamide in the bilateral cerebral hemispheres. Seven weeks later, the patient underwent aortic valve replacement, and his postoperative course was uneventful. Carotid endarterectomy rather than carotid artery stenting should be preceded for cervical carotid stenosis complicated with severe aortic valve stenosis.
一名75岁男性，曾接受冠状动脉搭桥术和腹主动脉瘤修复术，因严重主动脉瓣狭窄合并无症状双侧颈内动脉狭窄而患有心绞痛。脑灌注成像显示双侧大脑半球脑血流量减少以及对乙酰唑胺的脑血管反应性降低。首先，患者接受了左颈动脉内膜切除术，术后过程顺利。术后脑灌注成像显示双侧大脑半球对乙酰唑胺的脑血管反应性有所改善。七周后，患者接受了主动脉瓣置换术，术后过程也顺利。对于合并严重主动脉瓣狭窄的颈内动脉狭窄，应先行颈动脉内膜切除术而非颈动脉支架置入术。
