急性期脳梗塞に対する血栓回収療法の現状と近未来

前方循環系の脳主幹動脈閉塞を原因とする急性期脳梗塞に対する機械的血栓回収療法の有効性が, 2015年に発症早期例を, 2018年に発症時刻不明例や発症から時間の経過した症例を対象として証明された. 画像診断に基づく患者選択と, 発症から再開通までの時間短縮が転帰改善に強く影響することが明らかとなっている. 現在, 脳底動脈閉塞例や広範囲の虚血コアを有する症例を対象としたランダム化比較試験や, 血栓回収療法と神経保護薬の併用に関する試験が進行中である. さらに, 血栓回収療法を実地臨床へ広く普及させるために, 脳卒中救急診療体制の確立が重要な課題である....

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Published in脳神経外科ジャーナル Vol. 28; no. 9; pp. 552 - 560
Main Authors 猪原, 匡史, 豊田, 一則, 髙橋, 淳, 田中, 寛大, 古賀, 政利, 吉本, 武史, 山上, 宏, 井上, 学, 佐藤, 徹
Format Journal Article
LanguageJapanese
Published 日本脳神経外科コングレス 2019
Subjects
acute ischemic stroke
large vessel occulusion
mechanical thrombectomy
Online AccessGet full text
ISSN0917-950X
2187-3100
DOI10.7887/jcns.28.552

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Abstract 前方循環系の脳主幹動脈閉塞を原因とする急性期脳梗塞に対する機械的血栓回収療法の有効性が, 2015年に発症早期例を, 2018年に発症時刻不明例や発症から時間の経過した症例を対象として証明された. 画像診断に基づく患者選択と, 発症から再開通までの時間短縮が転帰改善に強く影響することが明らかとなっている. 現在, 脳底動脈閉塞例や広範囲の虚血コアを有する症例を対象としたランダム化比較試験や, 血栓回収療法と神経保護薬の併用に関する試験が進行中である. さらに, 血栓回収療法を実地臨床へ広く普及させるために, 脳卒中救急診療体制の確立が重要な課題である.
AbstractList 前方循環系の脳主幹動脈閉塞を原因とする急性期脳梗塞に対する機械的血栓回収療法の有効性が, 2015年に発症早期例を, 2018年に発症時刻不明例や発症から時間の経過した症例を対象として証明された. 画像診断に基づく患者選択と, 発症から再開通までの時間短縮が転帰改善に強く影響することが明らかとなっている. 現在, 脳底動脈閉塞例や広範囲の虚血コアを有する症例を対象としたランダム化比較試験や, 血栓回収療法と神経保護薬の併用に関する試験が進行中である. さらに, 血栓回収療法を実地臨床へ広く普及させるために, 脳卒中救急診療体制の確立が重要な課題である.
Author 田中, 寛大
吉本, 武史
古賀, 政利
猪原, 匡史
髙橋, 淳
山上, 宏
佐藤, 徹
井上, 学
豊田, 一則
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2) Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, Dippel DW ; MR CLEAN Investigators : A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372 : 11-20, 2015.
1) Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart RA, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG ; DEFUSE 3 Investigators : Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378 : 708-718, 2018.
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– reference: 11) Liu X, Xu G, Liu Y, Zhu W, Ma M, Xiong Y, Zi W, Dai Q, Leung T, Yan B, Davis S, Liebeskind DS, Pereira VM, Nogueira RG ; BEST Trial Investigators : Acute basilar artery occlusion : Endovascular interventions versus standard medical treatment (BEST) trial-design and protocol for a randomized, controlled, multicenter study. Int J Stroke 12 : 779-785, 2017.
– reference: 13) 日本脳卒中学会, 脳卒中ガイドライン委員会編 : 脳卒中治療ガイドライン2015 (追補2017対応). 2017.
– reference: 7) Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD ; ESCAPE Trial Investigators : Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372 : 1019-1030, 2015.
– reference: 19) Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CB, Dippel DW, Campbell BC, Nogueira RG, Demchuk AM, Tomasello A, Cardona P, Devlin TG, Frei DF, du Mesnil de Rochemont R, Berkhemer OA, Jovin TG, Siddiqui AH, van Zwam WH, Davis SM, Castaño C, Sapkota BL, Fransen PS, Molina C, van Oostenbrugge RJ, Chamorro Á, Lingsma H, Silver FL, Donnan GA, Shuaib A, Brown S, Stouch B, Mitchell PJ, Davalos A, Roos YB, Hill MD ; HERMES Collaborators : Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke : A meta-analysis. JAMA 316 : 1279-1288, 2016.
– reference: 20) Suzuki K, Nakajima N, Kunimoto K, Hatake S, Sakamoto Y, Hokama H, Nomura K, Hayashi T, Aoki J, Suda S, Nishiyama Y, Kimura K : Emergent large vessel occlusion screen is an ideal prehospital scale to avoid missing endovascular therapy in acute stroke. Stroke 49 : 2096-2101, 2018.
– reference: 16) Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL ; American Heart Association Stroke Council : 2018 guidelines for the early management of patients with acute ischemic stroke : A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49 : e46-e110, 2018.
– reference: 10) Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, Saleme S, Costalat V, Bracard S, Desal H, Mazighi M, Consoli A, Piotin M ; ASTER Trial Investigators : Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion : The ASTER randomized clinical trial. JAMA 318 : 443-452, 2017.
– reference: 12) Mistry EA, Mistry AM, Nakawah MO, Chitale RV, James RF, Volpi JJ, Fusco MR : Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients : A meta-analysis. Stroke 48 : 2450-2456, 2017.
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Snippet 前方循環系の脳主幹動脈閉塞を原因とする急性期脳梗塞に対する機械的血栓回収療法の有効性が, 2015年に発症早期例を, 2018年に発症時刻不明例や発症から時間の経過した症例を対象として証明された. 画像診断に基づく患者選択と, 発症から再開通までの時間短縮が転帰改善に強く影響することが明らかとなっている. 現在,...
SourceID jstage
SourceType Publisher
StartPage 552
SubjectTerms acute ischemic stroke
large vessel occulusion
mechanical thrombectomy
Title 急性期脳梗塞に対する血栓回収療法の現状と近未来
URI https://www.jstage.jst.go.jp/article/jcns/28/9/28_552/_article/-char/ja
Volume 28
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ispartofPNX 脳神経外科ジャーナル, 2019, Vol.28(9), pp.552-560
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