서울중앙병원에서의 경동맥 내막 절제술 : 경동맥 내막 절제술이 뇌관류, 혈관예비능 및 대뇌기능에 미치는 영향
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Background & Objective : Carotid endarterectomy (CEA), a reasonable modality to prevent ischemic stroke in the patients with severe carotid stenosis, had not been popular until in korea lately. We performed 107 cases of CEA between September 1995 to March 1999 in Asan Medical Center. The purpose of this study is to present our results, the largest case series in Korea, and to evaluate the influence of CEA on cerebral perfusion and cerebral function. Methods : In our protocol, same neurologist estimated the NIH stroke scale (NIHSS) and mini-mental status exam (MMSE) one or two days before CEA and 4-6 days after CEA. 99mTc-ECD perfusion Single Photon Emission Computerized Tomography (SPECT) with acetazolamide challenge was also performed at that time. We classified the results of SPECT in four types according to the status of cerebral perfusion and vascular reserve. One or two months later, we reevalutated the neurological status and the patency of the carotid artery. Resul ts ; NIHSS improved in 6 patients and worsened in 2, among 67 patients tested, while MMSE improved in 7 patients and worsened in 2, among 50. Four patients showed clear improvement in the language function, attention and orientation associated with increased cerebral perfusion and vascular reserve after CEA. Results of pre- and post-op SPECTs revealed that cerebral perfusion improved usually in those with decreased vascular reserve with or without perfusion defect (29/33) and rarely in others (1/37). Four patients (4.7%) developed stroke among 85 symptomatic carotid artery stenosis group, while none developed among 22 asymptomatic patients. No patient died within 30 days after CEA. Conclusion : In our study, the morbidity(3.7%) and mortality (0%) of CEA were low. Thus, CEA is a reasonable way of treatment for the carotid stenosis in Korean population. CEA can improve the cerebral perfusion in the patients with decreased vascular reserve, and may improve the cerebral function in selected patients. Korean Journal of Stroke 1999;1(1):52~58
Abstract
Background & Objective : Carotid endarterectomy (CEA), a reasonable modality to prevent ischemic stroke in the patients with severe carotid stenosis, had not been popular until in korea lately. We performed 107 cases of CEA between September 1995 to March 1999 in Asan Medical Center. The purpose of this study is to present our results, the largest case series in Korea, and to evaluate the influence of CEA on cerebral perfusion and cerebral function. Methods : In our protocol, same neurologist estimated the NIH stroke scale (NIHSS) and mini-mental status exam (MMSE) one or two days before CEA and 4-6 days after CEA. 99mTc-ECD perfusion Single Photon Emission Computerized Tomography (SPECT) with acetazolamide challenge was also performed at that time. We classified the results of SPECT in four types according to the status of cerebral perfusion and vascular reserve. One or two months later, we reevalutated the neurological status and the patency of the carotid artery. Resul ts ; NIHSS improved in 6 patients and worsened in 2, among 67 patients tested, while MMSE improved in 7 patients and worsened in 2, among 50. Four patients showed clear improvement in the language function, attention and orientation associated with increased cerebral perfusion and vascular reserve after CEA. Results of pre- and post-op SPECTs revealed that cerebral perfusion improved usually in those with decreased vascular reserve with or without perfusion defect (29/33) and rarely in others (1/37). Four patients (4.7%) developed stroke among 85 symptomatic carotid artery stenosis group, while none developed among 22 asymptomatic patients. No patient died within 30 days after CEA. Conclusion : In our study, the morbidity(3.7%) and mortality (0%) of CEA were low. Thus, CEA is a reasonable way of treatment for the carotid stenosis in Korean population. CEA can improve the cerebral perfusion in the patients with decreased vascular reserve, and may improve the cerebral function in selected patients. Korean Journal of Stroke 1999;1(1):52~58