tPA静注療法・血栓回収療法の現状と課題
tPA静注療法は発症後4.5時間以内に投与することが現在のコンセンサスであるが, 脳主幹動脈閉塞症に対する早期再開通は限定的である. 一方, 血栓回収療法は, 内科治療と比較した多くのランダム化試験で有効性が示された. 重要な点は, 発症から再開通までの時間が短いほど, 転帰良好例が多くなることである. また最近は灌流画像を用いて虚血ペナンブラの同定を行い症例選択すれば発症後時間が経過した症例にも血栓回収療法が有効であることが示されている. 脳主幹動脈閉塞症はこれら2つの治療により, 大幅に 「治る」 可能性の高い疾患となった. 今後, 適応症例を適切に選択し, すみやかに治療開始できる救急体...
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Published in | 脳神経外科ジャーナル Vol. 27; no. 7; pp. 505 - 513 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | Japanese |
Published |
日本脳神経外科コングレス
2018
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Subjects | |
Online Access | Get full text |
ISSN | 0917-950X 2187-3100 |
DOI | 10.7887/jcns.27.505 |
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Abstract | tPA静注療法は発症後4.5時間以内に投与することが現在のコンセンサスであるが, 脳主幹動脈閉塞症に対する早期再開通は限定的である. 一方, 血栓回収療法は, 内科治療と比較した多くのランダム化試験で有効性が示された. 重要な点は, 発症から再開通までの時間が短いほど, 転帰良好例が多くなることである. また最近は灌流画像を用いて虚血ペナンブラの同定を行い症例選択すれば発症後時間が経過した症例にも血栓回収療法が有効であることが示されている. 脳主幹動脈閉塞症はこれら2つの治療により, 大幅に 「治る」 可能性の高い疾患となった. 今後, 適応症例を適切に選択し, すみやかに治療開始できる救急体制の構築が重要となってくると考える. |
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AbstractList | tPA静注療法は発症後4.5時間以内に投与することが現在のコンセンサスであるが, 脳主幹動脈閉塞症に対する早期再開通は限定的である. 一方, 血栓回収療法は, 内科治療と比較した多くのランダム化試験で有効性が示された. 重要な点は, 発症から再開通までの時間が短いほど, 転帰良好例が多くなることである. また最近は灌流画像を用いて虚血ペナンブラの同定を行い症例選択すれば発症後時間が経過した症例にも血栓回収療法が有効であることが示されている. 脳主幹動脈閉塞症はこれら2つの治療により, 大幅に 「治る」 可能性の高い疾患となった. 今後, 適応症例を適切に選択し, すみやかに治療開始できる救急体制の構築が重要となってくると考える. |
Author | 矢坂, 正弘 宮崎, 雄一 中溝, 玲 黒木, 亮太 岡田, 靖 桑城, 貴弘 津本, 智幸 後藤, 聖司 |
Author_xml | – sequence: 1 fullname: 中溝, 玲 organization: 九州医療センター脳神経外科 – sequence: 1 fullname: 矢坂, 正弘 organization: 九州医療センター脳血管・神経内科 – sequence: 1 fullname: 後藤, 聖司 organization: 九州医療センター脳血管・神経内科 – sequence: 1 fullname: 桑城, 貴弘 organization: 九州医療センター脳血管・神経内科 – sequence: 1 fullname: 岡田, 靖 organization: 九州医療センター脳血管・神経内科 – sequence: 1 fullname: 津本, 智幸 organization: 九州医療センター脳血管内治療科 – sequence: 1 fullname: 黒木, 亮太 organization: 九州医療センター脳血管内治療科 – sequence: 1 fullname: 宮崎, 雄一 organization: 九州医療センター脳血管内治療科 |
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References_xml | – reference: 29) Yoon W, Kim SK, Heo TW, Baek BH, Lee YY, Kang HK : Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion. Stroke 46 : 2972-2975, 2015. – reference: 10) Hastrup S, Damgaard D, Johnsen SP, Andersen G : Prehospital acute stroke severity scale to predict large artery occlusion : design and comparison with other scales. 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Snippet | tPA静注療法は発症後4.5時間以内に投与することが現在のコンセンサスであるが, 脳主幹動脈閉塞症に対する早期再開通は限定的である. 一方, 血栓回収療法は, 内科治療と比... |
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StartPage | 505 |
SubjectTerms | cerebral embolism cerebral infarction mechanical thrombectomy randomized controlled trial tissue plasminogen activator |
Title | tPA静注療法・血栓回収療法の現状と課題 |
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