Dabigatran内服中の急性期脳主幹動脈閉塞に対し血栓回収術を施行した1例
NOAC内服中の脳主幹動脈閉塞患者に対する急性期再開通療法の明確な指針は現時点で示されていない. 今回dabigatran内服後早期に発症した脳梗塞の治療経験を報告する. 症例は58歳男性, 右片麻痺, 失語を主訴に発症後35分で救急搬送された. 心房細動, 心原性塞栓症の既往がありdabigatran内服中であった. 脳梗塞の診断となるも最終服薬後4時間であり, rt-PA静注療法は施行せずステント型血栓回収デバイスによる血栓回収術を施行し, 合併症なく完全再開通を得た. Dabigatran内服中にrt-PA静注療法を行う際は最終投与から7時間以上が1つの目安とされており, 内服後経過時間...
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| Published in | 脳神経外科ジャーナル Vol. 25; no. 7; pp. 592 - 597 |
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| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本脳神経外科コングレス
2016
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.25.592 |
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| Abstract | NOAC内服中の脳主幹動脈閉塞患者に対する急性期再開通療法の明確な指針は現時点で示されていない. 今回dabigatran内服後早期に発症した脳梗塞の治療経験を報告する. 症例は58歳男性, 右片麻痺, 失語を主訴に発症後35分で救急搬送された. 心房細動, 心原性塞栓症の既往がありdabigatran内服中であった. 脳梗塞の診断となるも最終服薬後4時間であり, rt-PA静注療法は施行せずステント型血栓回収デバイスによる血栓回収術を施行し, 合併症なく完全再開通を得た. Dabigatran内服中にrt-PA静注療法を行う際は最終投与から7時間以上が1つの目安とされており, 内服後経過時間の短い症例では, 血管内治療による血栓回収療法が考慮される. |
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| AbstractList | NOAC内服中の脳主幹動脈閉塞患者に対する急性期再開通療法の明確な指針は現時点で示されていない. 今回dabigatran内服後早期に発症した脳梗塞の治療経験を報告する. 症例は58歳男性, 右片麻痺, 失語を主訴に発症後35分で救急搬送された. 心房細動, 心原性塞栓症の既往がありdabigatran内服中であった. 脳梗塞の診断となるも最終服薬後4時間であり, rt-PA静注療法は施行せずステント型血栓回収デバイスによる血栓回収術を施行し, 合併症なく完全再開通を得た. Dabigatran内服中にrt-PA静注療法を行う際は最終投与から7時間以上が1つの目安とされており, 内服後経過時間の短い症例では, 血管内治療による血栓回収療法が考慮される. |
| Author | 木村, 仁 藤田, 聡 平井, 希 平元, 侑 岩渕, 聡 林, 盛人 青木, 和哉 齋藤, 紀彦 中山, 晴雄 |
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| References | 3) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L ; RE-LY Steering Committee and Investigators : Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361 : 1139-1151, 2009. 4) 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. 5) Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A ; REVASCAT Trial Investigators : Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372 : 2296-2306, 2015. 8) 日本脳卒中学会脳卒中医療向上・社会保険委員会, rt-PA静注療法指針改定部会 : rt-PA (アルテプラーゼ) 静注療法適正治療指針 第二版. 脳卒中 34 : 443-80, 2012. 9) Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R ; SWIFT PRIME Investigators : Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372 : 2285-2295, 2015. 10) 矢坂正弘 : 侵襲的治療時の対応, 大出血に対する対応. Heart View 16 : 72-78, 2012. 1) 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. 6) Moey AW, Koblar SA, Chryssidis S, Robinson M, Jannes J : Endovascular therapy after stroke in a patient treated with dabigatran. Med J Aust 196 : 469-471, 2012. 2) Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM ; EXTEND-IA Investigators : Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372 : 1009-1018, 2015. 7) Müller P, Topakian R, Sonnberger M, Nußbaumer K, Windpessl M, Eder V, Nesser HJ, Trenkler J, Haring HP : Endovascular thrombectomy for acute ischemic stroke patients anticoagulated with dabigatran. Clin Neurol Neurosurg 115 : 2257-2259, 2013. |
| References_xml | – reference: 3) Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L ; RE-LY Steering Committee and Investigators : Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361 : 1139-1151, 2009. – reference: 2) Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM ; EXTEND-IA Investigators : Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372 : 1009-1018, 2015. – reference: 4) 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: 6) Moey AW, Koblar SA, Chryssidis S, Robinson M, Jannes J : Endovascular therapy after stroke in a patient treated with dabigatran. Med J Aust 196 : 469-471, 2012. – reference: 5) Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Román L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A ; REVASCAT Trial Investigators : Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372 : 2296-2306, 2015. – reference: 8) 日本脳卒中学会脳卒中医療向上・社会保険委員会, rt-PA静注療法指針改定部会 : rt-PA (アルテプラーゼ) 静注療法適正治療指針 第二版. 脳卒中 34 : 443-80, 2012. – reference: 7) Müller P, Topakian R, Sonnberger M, Nußbaumer K, Windpessl M, Eder V, Nesser HJ, Trenkler J, Haring HP : Endovascular thrombectomy for acute ischemic stroke patients anticoagulated with dabigatran. Clin Neurol Neurosurg 115 : 2257-2259, 2013. – reference: 9) Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R ; SWIFT PRIME Investigators : Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372 : 2285-2295, 2015. – reference: 10) 矢坂正弘 : 侵襲的治療時の対応, 大出血に対する対応. Heart View 16 : 72-78, 2012. – reference: 1) 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. |
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| Snippet | NOAC内服中の脳主幹動脈閉塞患者に対する急性期再開通療法の明確な指針は現時点で示されていない. 今回dabigatran内服後早期に発症した脳梗塞の治療経験を報告する. 症例は58歳男性, 右片麻痺, 失語を主訴に発症後35分で救急搬送された. 心房細動,... |
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| SubjectTerms | dabigatran endovascular thrombectomy ischemic stroke NOAC |
| Title | Dabigatran内服中の急性期脳主幹動脈閉塞に対し血栓回収術を施行した1例 |
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