脳卒中における血管内治療の現状と新展開
脳卒中疾患の中でも血管内治療の機会が多い，破裂脳動脈瘤のコイル塞栓術，頸動脈狭窄に対するステント留置術，急性期脳梗塞の機械的血栓回収療法について，関連する最近の大規模臨床試験の結果も含め概説する。まずコイル塞栓術では，様々なコイルおよび補助デバイスの登場により治療適応が拡大され，さらには治療成績の向上につながっていることを述べる。ステント留置術については，虚血性合併症の低減のために使用される各種デバイスと今後の課題について述べる。最後に，急性期脳主幹動脈閉塞に対する新たな治療である機械的血栓回収療法及び使用されるMerci RetrieverとPenumbra systemについて解説する。...
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| Published in | 杏林医学会雑誌 Vol. 44; no. 4; pp. 209 - 218 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
杏林医学会
2013
|
| Online Access | Get full text |
| ISSN | 0368-5829 1349-886X |
| DOI | 10.11434/kyorinmed.44.209 |
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| Abstract | 脳卒中疾患の中でも血管内治療の機会が多い，破裂脳動脈瘤のコイル塞栓術，頸動脈狭窄に対するステント留置術，急性期脳梗塞の機械的血栓回収療法について，関連する最近の大規模臨床試験の結果も含め概説する。まずコイル塞栓術では，様々なコイルおよび補助デバイスの登場により治療適応が拡大され，さらには治療成績の向上につながっていることを述べる。ステント留置術については，虚血性合併症の低減のために使用される各種デバイスと今後の課題について述べる。最後に，急性期脳主幹動脈閉塞に対する新たな治療である機械的血栓回収療法及び使用されるMerci RetrieverとPenumbra systemについて解説する。 |
|---|---|
| AbstractList | 脳卒中疾患の中でも血管内治療の機会が多い，破裂脳動脈瘤のコイル塞栓術，頸動脈狭窄に対するステント留置術，急性期脳梗塞の機械的血栓回収療法について，関連する最近の大規模臨床試験の結果も含め概説する。まずコイル塞栓術では，様々なコイルおよび補助デバイスの登場により治療適応が拡大され，さらには治療成績の向上につながっていることを述べる。ステント留置術については，虚血性合併症の低減のために使用される各種デバイスと今後の課題について述べる。最後に，急性期脳主幹動脈閉塞に対する新たな治療である機械的血栓回収療法及び使用されるMerci RetrieverとPenumbra systemについて解説する。 |
| Author | 島田, 篤 佐藤, 栄志 |
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| Copyright | 2013 杏林医学会 |
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| DOI | 10.11434/kyorinmed.44.209 |
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| References | 9）White PM, Lewis SC, Gholkar A, Sellar RJ, Nahser H, Cognard C, Forrester L, Wardlaw JM; HELPS trial collaborators. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet 377: 1655―62, 2011. 20）Verzini F, De Rango P, Parlani G, Giordano G, Caso V, Cieri E, Isernia G, Cao P. Effects of statins on early and late results of carotid stenting. J Vasc Surg 53: 71―79, 2011. 14）International Carotid Stenting Study investigators, Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ, Lo TH, Gaines P, Dorman PJ, Macdonald S, Lyrer PA, Hendriks JM, McCollum C, Nederkoorn PJ, Brown MM. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375: 985―97, 2010. 5）CARAT Investigators. Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke 37: 1437―42, 2006. 3）Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M, Rischmiller J; ISAT Collaborators. Risk of recurrent subarachnoid hemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. The Lancet Neurology 8: 427―33, 2009. 22）坂井信幸，植田敏浩，早川幹人，長畑守雄，大田慎三，中原一郎，木村和美，吉村紳一，江面正幸，山崎信吾，松本康史，西野和彦，豊田真吾，山崎弘幸，恩田敏之，山上 宏，今村博敏．MERCIリトリーバーを用いた急性脳動脈再開通療法―我が国における初期周術期成績―．JRNET 5: 23―31, 2011 16）Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N engl J Med. 363: 11―23, 2010. 6）McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, Albuquerque FC. The Barrow Ruptured Aneurysm Trial. J Neurosurg. 116: 135―44, 2012. 18）Takaya N, Yuan C, Chu B, Saam T, Underhill H, Cai J, Tran N, Polissar NL, Isaac C, Ferguson MS, Garden GA, Cramer SC, Maravilla KR, Hashimoto B, Hatsukami TS. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI―initial results. Stroke 37: 818―823, 2006. 7）Spetzler RF, McDougall CG, Albuquerque FC, Zabramski JM, Hills NK, Partovi S, Nakaji P, Wallace RC. The Barrow Ruptured Aneurysm Trial: 3-year results. J Neurosurg. 119: 146―57, 2013. 24）Dvalos A, Pereira VM, Chapot R, Bonaf A, Andersson T, Gralla J; Solitaire Group. Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke 43: 2699―705, 2012. 2）Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysmal Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366: 809―17, 2005. 21）Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, Lutsep HL, Rymer MM, Higashida RT, Starkman S, Gobin YP; Multi MERCI Investigators, Frei D, Grobelny T, Hellinger F, Huddle D, Kidwell C, Koroshetz W, Marks M, Nesbit G, Silverman IE. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39: 1205―12, 2008. 25）Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO; SWIFT Trialists. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380: 1241―9, 2012. 8）White PM, Lewis SC, Nahser H, Sellar RJ, Goddard T, Gholkar A; HELPS Trial Collaboration. HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS Trial) Procedual Safety and Operator-Assessed Efficacy Results. AJNR 29: 217―23, 2008. 17）Silver FL, Mackey A, Clark WM, Brooks W, Timaran CH, Chiu D, Goldstein LB, Meschia JF, Ferguson RD, Moore WS, Howard G, Brott TG; CREST Investigators. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke 42: 675―680, 2011. 1）Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysmal Trial (ISAT) Collaborative Group: International Subarachnoid Aneurysmal Trial of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomized trial. Lancet 360: 1267―74, 2002. 10）Niimi Y, Song J, Madrid M, Berenstein A. Endosaccular Treatment of Intracranial Aneurysms Using Matrix Coils: Early Experience and Midterm Follow-Up. Stroke 37: 1028―32, 2006. 4）Scott RB, Eccles F, Molyneux AJ, Kerr RS, Rothwell PM, Carpenter K. Improved Cognitive Outcomes With Endovascular Coiling of Ruptured Intracranial Aneurysms Neuropsychological Outcomes From the International Subarachnoid Aneurysm Trial (ISAT). Stroke 41: 1743―7, 2010. 23）Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 40: 2761―8, 2009. 15）Howard VJ, Voeks JH, Lutsep HL, Mackey A, Milot G, Sam AD 2nd, Tom M, Hughes SE, Sheffet AJ, Longbottom M, Avery JB, Hobson RW 2nd, Brott TG. Does sex matter? Thirty-day stroke and death rates after carotid artery stenting in women versus men: results from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) lead-in phase. Stroke 40: 1140―7, 2009. 12）Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, Larrue V, Livre M, Leys D, Bonneville JF, Watelet J, Pruvo JP, Albucher JF, Viguier A, Piquet P, Garnier P, Viader F, Touz E, Giroud M, Hosseini H, Pillet JC, Favrole P, Neau JP, Ducrocq X; EVA-3S Investigators. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 355: 1660―71, 2006. 13）SPACE Collaborative Group, Ringleb PA, Allenberg J, Brckmann H, Eckstein HH, Fraedrich G, Hartmann M, Hennerici M, Jansen O, Klein G, Kunze A, Marx P, Niederkorn K, Schmiedt W, Solymosi L, Stingele R, Zeumer H, Hacke W. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368: 1239―47, 2006. 19）Yamada K, Kawasaki M, Yoshimura S, Enomoto Y, Asano T, Minatoguchi S, Iwama T. Prediction of silent ischemic lesions after carotid artery stenting using integrated backscatter ultrasound and magnetic resonance imaging. Atherosclerosis 208: 161―166, 2010. 11）Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 351: 1493―501, 2004. |
| References_xml | – reference: 4）Scott RB, Eccles F, Molyneux AJ, Kerr RS, Rothwell PM, Carpenter K. Improved Cognitive Outcomes With Endovascular Coiling of Ruptured Intracranial Aneurysms Neuropsychological Outcomes From the International Subarachnoid Aneurysm Trial (ISAT). Stroke 41: 1743―7, 2010. – reference: 18）Takaya N, Yuan C, Chu B, Saam T, Underhill H, Cai J, Tran N, Polissar NL, Isaac C, Ferguson MS, Garden GA, Cramer SC, Maravilla KR, Hashimoto B, Hatsukami TS. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI―initial results. Stroke 37: 818―823, 2006. – reference: 13）SPACE Collaborative Group, Ringleb PA, Allenberg J, Brckmann H, Eckstein HH, Fraedrich G, Hartmann M, Hennerici M, Jansen O, Klein G, Kunze A, Marx P, Niederkorn K, Schmiedt W, Solymosi L, Stingele R, Zeumer H, Hacke W. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet 368: 1239―47, 2006. – reference: 17）Silver FL, Mackey A, Clark WM, Brooks W, Timaran CH, Chiu D, Goldstein LB, Meschia JF, Ferguson RD, Moore WS, Howard G, Brott TG; CREST Investigators. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke 42: 675―680, 2011. – reference: 14）International Carotid Stenting Study investigators, Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ, Lo TH, Gaines P, Dorman PJ, Macdonald S, Lyrer PA, Hendriks JM, McCollum C, Nederkoorn PJ, Brown MM. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet 375: 985―97, 2010. – reference: 15）Howard VJ, Voeks JH, Lutsep HL, Mackey A, Milot G, Sam AD 2nd, Tom M, Hughes SE, Sheffet AJ, Longbottom M, Avery JB, Hobson RW 2nd, Brott TG. Does sex matter? Thirty-day stroke and death rates after carotid artery stenting in women versus men: results from the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) lead-in phase. Stroke 40: 1140―7, 2009. – reference: 12）Mas JL, Chatellier G, Beyssen B, Branchereau A, Moulin T, Becquemin JP, Larrue V, Livre M, Leys D, Bonneville JF, Watelet J, Pruvo JP, Albucher JF, Viguier A, Piquet P, Garnier P, Viader F, Touz E, Giroud M, Hosseini H, Pillet JC, Favrole P, Neau JP, Ducrocq X; EVA-3S Investigators. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis. N Engl J Med. 355: 1660―71, 2006. – reference: 19）Yamada K, Kawasaki M, Yoshimura S, Enomoto Y, Asano T, Minatoguchi S, Iwama T. Prediction of silent ischemic lesions after carotid artery stenting using integrated backscatter ultrasound and magnetic resonance imaging. Atherosclerosis 208: 161―166, 2010. – reference: 20）Verzini F, De Rango P, Parlani G, Giordano G, Caso V, Cieri E, Isernia G, Cao P. Effects of statins on early and late results of carotid stenting. J Vasc Surg 53: 71―79, 2011. – reference: 21）Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, Lutsep HL, Rymer MM, Higashida RT, Starkman S, Gobin YP; Multi MERCI Investigators, Frei D, Grobelny T, Hellinger F, Huddle D, Kidwell C, Koroshetz W, Marks M, Nesbit G, Silverman IE. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39: 1205―12, 2008. – reference: 22）坂井信幸，植田敏浩，早川幹人，長畑守雄，大田慎三，中原一郎，木村和美，吉村紳一，江面正幸，山崎信吾，松本康史，西野和彦，豊田真吾，山崎弘幸，恩田敏之，山上 宏，今村博敏．MERCIリトリーバーを用いた急性脳動脈再開通療法―我が国における初期周術期成績―．JRNET 5: 23―31, 2011． – reference: 9）White PM, Lewis SC, Gholkar A, Sellar RJ, Nahser H, Cognard C, Forrester L, Wardlaw JM; HELPS trial collaborators. Hydrogel-coated coils versus bare platinum coils for the endovascular treatment of intracranial aneurysms (HELPS): a randomised controlled trial. Lancet 377: 1655―62, 2011. – reference: 23）Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 40: 2761―8, 2009. – reference: 1）Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysmal Trial (ISAT) Collaborative Group: International Subarachnoid Aneurysmal Trial of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomized trial. Lancet 360: 1267―74, 2002. – reference: 24）Dvalos A, Pereira VM, Chapot R, Bonaf A, Andersson T, Gralla J; Solitaire Group. Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke 43: 2699―705, 2012. – reference: 3）Molyneux AJ, Kerr RS, Birks J, Ramzi N, Yarnold J, Sneade M, Rischmiller J; ISAT Collaborators. Risk of recurrent subarachnoid hemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up. The Lancet Neurology 8: 427―33, 2009. – reference: 10）Niimi Y, Song J, Madrid M, Berenstein A. Endosaccular Treatment of Intracranial Aneurysms Using Matrix Coils: Early Experience and Midterm Follow-Up. Stroke 37: 1028―32, 2006. – reference: 11）Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K; Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 351: 1493―501, 2004. – reference: 6）McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, Nakaji P, Albuquerque FC. The Barrow Ruptured Aneurysm Trial. J Neurosurg. 116: 135―44, 2012. – reference: 7）Spetzler RF, McDougall CG, Albuquerque FC, Zabramski JM, Hills NK, Partovi S, Nakaji P, Wallace RC. The Barrow Ruptured Aneurysm Trial: 3-year results. J Neurosurg. 119: 146―57, 2013. – reference: 5）CARAT Investigators. Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke 37: 1437―42, 2006. – reference: 2）Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, Sandercock P; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International Subarachnoid Aneurysmal Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomized comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366: 809―17, 2005. – reference: 8）White PM, Lewis SC, Nahser H, Sellar RJ, Goddard T, Gholkar A; HELPS Trial Collaboration. HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS Trial) Procedual Safety and Operator-Assessed Efficacy Results. AJNR 29: 217―23, 2008. – reference: 16）Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, Mackey A, Hill MD, Leimgruber PP, Sheffet AJ, Howard VJ, Moore WS, Voeks JH, Hopkins LN, Cutlip DE, Cohen DJ, Popma JJ, Ferguson RD, Cohen SN, Blackshear JL, Silver FL, Mohr JP, Lal BK, Meschia JF; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N engl J Med. 363: 11―23, 2010. – reference: 25）Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, Clark W, Budzik R, Zaidat OO; SWIFT Trialists. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380: 1241―9, 2012. |
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| Title | 脳卒中における血管内治療の現状と新展開 |
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| ispartofPNX | 杏林医学会雑誌, 2013, Vol.44(4), pp.209-218 |
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