脳への塞栓源としての大動脈弓部粥腫の超音波診断
「はじめに」大動脈の上行部から弓部は脳への循環より中枢側に位置するため,同部の粥腫は脳塞栓の原因となり得る.しかしながら1980年代までは脳卒中と大動脈病変の関連が論じられたことは極めて稀であり,1990年代に各種画像診断,とくに経食道心エコー(transesophageal echocardiography：TEE)が普及してから,いわゆるaortogenicembolicstroke(大動脈原性脳塞栓症)iglの重要性がはじめて学会や専門誌で採り上げられるようになった.大動脈弓部粥腫の超音波診断法は統一されておらず,現在日本脳神経超音波学会でガイドラインを作成中である.ここでは,脳塞栓源と...
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| Published in | Neurosonology Vol. 18; no. 2+3; pp. 58 - 62 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人日本脳神経超音波学会
2005
日本脳神経超音波学会 |
| Online Access | Get full text |
| ISSN | 0917-074X |
| DOI | 10.2301/neurosonology.18.58 |
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| Abstract | 「はじめに」大動脈の上行部から弓部は脳への循環より中枢側に位置するため,同部の粥腫は脳塞栓の原因となり得る.しかしながら1980年代までは脳卒中と大動脈病変の関連が論じられたことは極めて稀であり,1990年代に各種画像診断,とくに経食道心エコー(transesophageal echocardiography：TEE)が普及してから,いわゆるaortogenicembolicstroke(大動脈原性脳塞栓症)iglの重要性がはじめて学会や専門誌で採り上げられるようになった.大動脈弓部粥腫の超音波診断法は統一されておらず,現在日本脳神経超音波学会でガイドラインを作成中である.ここでは,脳塞栓源としての大動脈粥腫病変の意義を解説する.「脳塞栓源としての大動脈病変：病理学的探求」大動脈弓の粥腫は,高齢者に好発する病態である.大動脈の動脈硬化は,病理学的に正常,びまん性内膜肥厚,単純粥腫,複合病変の4段階に分けられ,複合病変は潰瘍や石灰化などを含む動脈硬化の最終型で,塞栓源たり得る状態といえる(Fig.1 19). |
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| AbstractList | 「はじめに」大動脈の上行部から弓部は脳への循環より中枢側に位置するため,同部の粥腫は脳塞栓の原因となり得る.しかしながら1980年代までは脳卒中と大動脈病変の関連が論じられたことは極めて稀であり,1990年代に各種画像診断,とくに経食道心エコー(transesophageal echocardiography：TEE)が普及してから,いわゆるaortogenicembolicstroke(大動脈原性脳塞栓症)iglの重要性がはじめて学会や専門誌で採り上げられるようになった.大動脈弓部粥腫の超音波診断法は統一されておらず,現在日本脳神経超音波学会でガイドラインを作成中である.ここでは,脳塞栓源としての大動脈粥腫病変の意義を解説する.「脳塞栓源としての大動脈病変：病理学的探求」大動脈弓の粥腫は,高齢者に好発する病態である.大動脈の動脈硬化は,病理学的に正常,びまん性内膜肥厚,単純粥腫,複合病変の4段階に分けられ,複合病変は潰瘍や石灰化などを含む動脈硬化の最終型で,塞栓源たり得る状態といえる(Fig.1 19). |
| Author | 豊田, 一則 |
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| DOI | 10.2301/neurosonology.18.58 |
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| References | 15) Strong JP, Restrepo C, Guzman M: Coronary and aortic atherosclerosis in New Orleans. II. Comparison of lesions by age, sex, and race. Lab Invest 39: 364-369, 1978 3) Beal MF, Williams RS, Richardson EP Jr, Fisher CM: Cholesterol embolism as a cause of transient ischemic attacks and cerebral infarction. Neurology 31: 860-865, 1981 8) Kazui S, Levi CR, Jones EF, Quang L, Calafiore P, Donnan GA: Risk factors for lacunar stroke: a case-control transesophageal echocardiographic study. Neurology 54: 1385-1387, 2000 12) Mitusch R, Doherty C, Wucherpfennig H, Memmesheimer C, Tepe C, Stierle U, Kessler C, Sheikhzadeh A: Vascular events during follow-up in patients with aortic arch atherosclerosis. Stroke 28: 36-39, 1997 19) Toyoda K, Yasaka M, Nagata S, Yamaguchi T: Aortogenic embolic stroke: a transesophageal echocardiographic approach. Stroke 23: 1056-1061, 1992 21) Tunick PA, Rosenzweig BP, Katz ES, Freedberg RS, Perez JL, Kronzon I: High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol 23: 1085-1090, 1994 10) Macleod MR, Amarenco P, Davis SM, Donnan GA: Atheroma of the aortic arch: an important and poorly recognised factor in the aetiology of stroke. Lancet Neurol 3: 408-414, 2004 7) Karalis DG, Chandrasekaran K, Victor MF, Ross JJ Jr, Mintz GS. Recognition and embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol 17: 73-78, 1991 16) Tanaka M, Yasaka M, Nagano K, Otsubo R, Oe H, Naritomi H: Moderate atheroma of the aortic arch and the risk of stroke. Cerebrovasc Dis 21: 26-31, 2006 5) Ferrari E, Vidal R, Chevallier T, Baudouy M: Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: benefit of oral anticoagulants. J Am Coll Cardiol 33: 1317-1322, 1999 9) Kazui S, Levi CR, Jones EF, Quang L, Calafiore P, Donnan GA: Lacunar stroke: transoesophageal echocardiographic factors influencing long-term prognosis. Cerebrovasc Dis 12: 325-330, 2001 1) Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, Chauvel C, Touboul PJ, Bousser MG: Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 331: 1474-1479, 1994 2) Amarenco P, Duyckaerts C, Tzourio C, Henin D, Bousser MG, Hauw JJ: The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med 326: 221-225, 1992 13) Otsubo R, Yasaka M, Nagatsuka K, Minamatsu K, Yamaguchi T: The role of the aortic arch atherosclerosis in embolic stroke. Stroke 29: 308, 1998 Abstract 14) Soloway HB, Aronson SM: Atheromatous emboli to central nervous system: report of 16 cases. Arch Neurol. 11: 657-667, 1964 11) Masuda J, Yutani C, Ogata J, Kuriyama Y, Yamaguchi T: Atheromatous embolism in the brain: a clinicopathologic analysis of 15 autopsy cases. Neurology 44: 1231-1237, 1994 18) The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography: Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. Ann Intern Med 128: 639-647, 1998 17) The French Study of Aortic Plaques in Stroke Group: Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. N Engl J Med 334: 1216-1221, 1996 20) Tunick PA, Perez JL, Kronzon I: Protruding atheromas in the thoracic aorta and systemic embolization. Ann Intern Med 115: 423-427, 1991 4) Donnan GA, Davis SM, Jones EF, Amarenco P: Aortic Source of Brain Embolism. Curr Treat Options Cardiovasc Med 5: 211-219, 2003 6) Fujimoto S, Yasaka M, Otsubo R, Oe H, Nagatsuka K, Minematsu K: Aortic arch atherosclerotic lesions and the recurrence of ischemic stroke. Stroke 35: 1426-1429, 2004 |
| References_xml | – reference: 16) Tanaka M, Yasaka M, Nagano K, Otsubo R, Oe H, Naritomi H: Moderate atheroma of the aortic arch and the risk of stroke. Cerebrovasc Dis 21: 26-31, 2006 – reference: 5) Ferrari E, Vidal R, Chevallier T, Baudouy M: Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: benefit of oral anticoagulants. J Am Coll Cardiol 33: 1317-1322, 1999 – reference: 6) Fujimoto S, Yasaka M, Otsubo R, Oe H, Nagatsuka K, Minematsu K: Aortic arch atherosclerotic lesions and the recurrence of ischemic stroke. Stroke 35: 1426-1429, 2004 – reference: 7) Karalis DG, Chandrasekaran K, Victor MF, Ross JJ Jr, Mintz GS. Recognition and embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol 17: 73-78, 1991 – reference: 12) Mitusch R, Doherty C, Wucherpfennig H, Memmesheimer C, Tepe C, Stierle U, Kessler C, Sheikhzadeh A: Vascular events during follow-up in patients with aortic arch atherosclerosis. Stroke 28: 36-39, 1997 – reference: 17) The French Study of Aortic Plaques in Stroke Group: Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. N Engl J Med 334: 1216-1221, 1996 – reference: 20) Tunick PA, Perez JL, Kronzon I: Protruding atheromas in the thoracic aorta and systemic embolization. Ann Intern Med 115: 423-427, 1991 – reference: 21) Tunick PA, Rosenzweig BP, Katz ES, Freedberg RS, Perez JL, Kronzon I: High risk for vascular events in patients with protruding aortic atheromas: a prospective study. J Am Coll Cardiol 23: 1085-1090, 1994 – reference: 19) Toyoda K, Yasaka M, Nagata S, Yamaguchi T: Aortogenic embolic stroke: a transesophageal echocardiographic approach. Stroke 23: 1056-1061, 1992 – reference: 18) The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography: Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. Ann Intern Med 128: 639-647, 1998 – reference: 2) Amarenco P, Duyckaerts C, Tzourio C, Henin D, Bousser MG, Hauw JJ: The prevalence of ulcerated plaques in the aortic arch in patients with stroke. N Engl J Med 326: 221-225, 1992 – reference: 13) Otsubo R, Yasaka M, Nagatsuka K, Minamatsu K, Yamaguchi T: The role of the aortic arch atherosclerosis in embolic stroke. Stroke 29: 308, 1998 Abstract – reference: 10) Macleod MR, Amarenco P, Davis SM, Donnan GA: Atheroma of the aortic arch: an important and poorly recognised factor in the aetiology of stroke. Lancet Neurol 3: 408-414, 2004 – reference: 11) Masuda J, Yutani C, Ogata J, Kuriyama Y, Yamaguchi T: Atheromatous embolism in the brain: a clinicopathologic analysis of 15 autopsy cases. Neurology 44: 1231-1237, 1994 – reference: 1) Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson G, Chauvel C, Touboul PJ, Bousser MG: Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 331: 1474-1479, 1994 – reference: 4) Donnan GA, Davis SM, Jones EF, Amarenco P: Aortic Source of Brain Embolism. Curr Treat Options Cardiovasc Med 5: 211-219, 2003 – reference: 3) Beal MF, Williams RS, Richardson EP Jr, Fisher CM: Cholesterol embolism as a cause of transient ischemic attacks and cerebral infarction. Neurology 31: 860-865, 1981 – reference: 9) Kazui S, Levi CR, Jones EF, Quang L, Calafiore P, Donnan GA: Lacunar stroke: transoesophageal echocardiographic factors influencing long-term prognosis. Cerebrovasc Dis 12: 325-330, 2001 – reference: 14) Soloway HB, Aronson SM: Atheromatous emboli to central nervous system: report of 16 cases. Arch Neurol. 11: 657-667, 1964 – reference: 8) Kazui S, Levi CR, Jones EF, Quang L, Calafiore P, Donnan GA: Risk factors for lacunar stroke: a case-control transesophageal echocardiographic study. Neurology 54: 1385-1387, 2000 – reference: 15) Strong JP, Restrepo C, Guzman M: Coronary and aortic atherosclerosis in New Orleans. II. Comparison of lesions by age, sex, and race. Lab Invest 39: 364-369, 1978 |
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| Snippet | 「はじめに」大動脈の上行部から弓部は脳への循環より中枢側に位置するため,同部の粥腫は脳塞栓の原因となり得る.しかしながら1980年代までは脳卒中と大動脈病変の関連が論じられたことは極めて稀であり,1990年代に各種画像診断,とくに経食道心エコー(transesophageal... |
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| Title | 脳への塞栓源としての大動脈弓部粥腫の超音波診断 |
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