Takeshita Tomonori, Ishihara Kohei, Murakami Yuu, Munakata Hiroshi, Mabuni Katsuhito, Kugai Tadao, Nagamine Tomoaki
Department of Neurosurgery, Prefectural Okinawa Nanbu Medical Center and Childre's Medical Center.
No Shinkei Geka. 2017 May;45(5):409-415. doi: 10.11477/mf.1436203524.
We report a case of concomitant carotid endarterectomy(CEA)and aortic valve replacement(AVR)for symptomatic severe carotid artery and aortic valve stenosis(AS). A 77-year-old man, presented to our hospital with AS complicated by right internal carotid artery(ICA)stenosis and left ICA occlusion, seeking treatment for AS. He suffered from left hemiparesis, and diffusion-weighted magnetic resonance imaging(MRI)showed multiple ischemic lesions in the right cerebral hemisphere. He was admitted to our neurosurgical department and received treatment for acute cerebral infarction caused by severe right ICA stenosis. The symptomatic severe right ICA stenosis was an indication for surgical treatment, but simple carotid revascularization of the stenosed ICA was considered to be deteriorated the cardiac function due to untreated AS. Thus, we decided to perform concomitant carotid and valvular surgery. The patient underwent a combined CEA and AVR procedure with the introduction of an intraoperative intra-aortic balloon pump. His postoperative course was uneventful even 12 months after the surgery. Management and surgical strategies for patients with concomitant ICA stenosis and AS continue to be controversial subjects. Combined carotid and cardiac valve surgery is considered to be effective in such cases, and we discuss its implications and review of literature.
我们报告一例因症状性重度颈动脉和主动脉瓣狭窄（AS）而行同期颈动脉内膜切除术（CEA）和主动脉瓣置换术（AVR）的病例。一名77岁男性因AS合并右颈内动脉（ICA）狭窄及左ICA闭塞就诊于我院，寻求AS治疗。他患有左侧偏瘫，弥散加权磁共振成像（MRI）显示右侧大脑半球多发缺血性病变。他被收入我院神经外科，接受了因重度右ICA狭窄导致的急性脑梗死治疗。症状性重度右ICA狭窄是手术治疗的指征，但单纯对狭窄的ICA进行颈动脉血运重建被认为会因未治疗的AS而使心功能恶化。因此，我们决定同期进行颈动脉和瓣膜手术。患者在术中使用主动脉内球囊泵的情况下接受了CEA和AVR联合手术。即使在术后12个月，他的术后病程也很顺利。合并ICA狭窄和AS患者的管理及手术策略仍是有争议的话题。颈动脉和心脏瓣膜联合手术在这类病例中被认为是有效的，我们讨论其意义并回顾文献。
