超音波による血管閉塞予防法開発のための基礎的検討
「はじめに」急性脳梗塞 (acute ischemic stroke : AIS) 患者の治療法として, intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) が広く実施され著効を示している. 一方で, IV rt-PA療法により血流が再開通したにもかかわらず, 血栓が再成長するなどの理由より, IV rt-PA療法後24時間以内に14～34%の高確率で血管の再閉塞を発症してしまうという問題を抱えている. しかし, IV rt-PA療法後24時間以内に再閉塞予防を目的に抗血小板薬を投与すると, 症候性頭蓋内...
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| Published in | Neurosonology Vol. 30; no. 1; pp. 4 - 7 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Kurashiki
一般社団法人日本脳神経超音波学会
01.01.2017
日本脳神経超音波学会 Japan Science and Technology Agency |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-074X 1884-3336 |
| DOI | 10.2301/neurosonology.30.4 |
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| Abstract | 「はじめに」急性脳梗塞 (acute ischemic stroke : AIS) 患者の治療法として, intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) が広く実施され著効を示している. 一方で, IV rt-PA療法により血流が再開通したにもかかわらず, 血栓が再成長するなどの理由より, IV rt-PA療法後24時間以内に14～34%の高確率で血管の再閉塞を発症してしまうという問題を抱えている. しかし, IV rt-PA療法後24時間以内に再閉塞予防を目的に抗血小板薬を投与すると, 症候性頭蓋内出血の頻度が顕著に高くなることが報告されており, 脳梗塞治療ガイドライン2015においても再閉塞予防を目的とした抗凝固薬などの薬剤の使用は認められていない. そのため, 一刻も早い新規血管再閉塞予防法の開発が望まれる. |
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| AbstractList | 「はじめに」急性脳梗塞 (acute ischemic stroke : AIS) 患者の治療法として, intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) が広く実施され著効を示している. 一方で, IV rt-PA療法により血流が再開通したにもかかわらず, 血栓が再成長するなどの理由より, IV rt-PA療法後24時間以内に14～34%の高確率で血管の再閉塞を発症してしまうという問題を抱えている. しかし, IV rt-PA療法後24時間以内に再閉塞予防を目的に抗血小板薬を投与すると, 症候性頭蓋内出血の頻度が顕著に高くなることが報告されており, 脳梗塞治療ガイドライン2015においても再閉塞予防を目的とした抗凝固薬などの薬剤の使用は認められていない. そのため, 一刻も早い新規血管再閉塞予防法の開発が望まれる. Background: Reocclusion occurred after various recanalization therapies. In particular, reocclusion was frequently observed immediately after the recombinant tissue-type plasminogen activator (rt-PA) treatment. This is a fatal problem, because anticoagulant therapy is prohibited within 24 hours after the rt-PA treatment. We report the thrombus growth control effect of non-invasive ultrasound (US) in an in vitro clot growth model. Method: A clot was prepared by incubation of citrated human plasma, CaCl2 solution and thrombin at 37°C for 60 min in a latex tube. After incubation, the latex tube was filled with degassed citrated human plasma. The plasma around the clot was irradiated with US in a water bath at 37°C. The US irradiation condition was: transducer size 10 mm, frequency 500 kHz, continuous wave, average intensity 0.32 W/cm2, 30 min. To evaluate the thrombus growth control effect, the clot’s weight was measured before and after US irradiation. Results: The clot’s increased weight was significantly suppressed in the US group compared with the Non-US group (58.3 mg vs. 107.7 mg, p<0.0025). Conclusions: In this study, we showed that the non-invasive US could control the growth of thrombus. This safe and simple US method may be used to prevent the reocclusion after recanalization therapy. |
| Author | 中島, 孝則 立花, 研 王, 作軍 中田, 典生 菊池, 蘭 山本, 博之 伊藤, 創馬 澤口, 能一 |
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| DOI | 10.2301/neurosonology.30.4 |
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| References | 8)Barreto AD, Alexandrov AV, Lyden P, et al.: The argatroban and tissue-type plasminogen activator stroke study: final results of a pilot safety study. Stroke 2012; 43: 770-775. 4)Alexandrov AV, Molina CA, Grotta JC, et al.: Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 2004; 351: 2170-2178. 6)Azuma T, Kawabata K, Umemura S, et al.: Bubble Generation by Standing Wave in Water Surrounded by Cranium with Transcranial Ultrasonic Beam. Jpn J Appl Phys 2005; 44: 4625-4630. 2)Graham GD: Tissue plasminogen activator for acute ischemic stroke in clinical practice: a meta-analysis of safety data. Stroke 2003; 34: 2847-2850. 3)澤口能一，王作軍，古幡博: 超音波は血栓成長を抑制する―塞栓成長抑制・再閉塞予防の可能性―. J Med Ultrasonic 2011; 38: 549-555. 5)Daffertshofer M, Gass A, Ringleb P, et al.: Transcranial low-frequency ultrasound-mediated thrombolysis in brain ischemia: increased risk of hemorrhage with combined ultrasound and tissue plasminogen activator: results of a phase II clinical trial. Stroke 2005; 36: 1441-1446. 1)Zinkstok SM, Roos YB, ARTIS investigators: Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet 2012; 380: 731-737. 7)Furuhata H, Saito O: Comparative study of standing wave reduction methods using random modulation for transcranial ultrasonication. Ultrasound Med Biol 2013; 39: 1440-1450. |
| References_xml | – reference: 5)Daffertshofer M, Gass A, Ringleb P, et al.: Transcranial low-frequency ultrasound-mediated thrombolysis in brain ischemia: increased risk of hemorrhage with combined ultrasound and tissue plasminogen activator: results of a phase II clinical trial. Stroke 2005; 36: 1441-1446. – reference: 7)Furuhata H, Saito O: Comparative study of standing wave reduction methods using random modulation for transcranial ultrasonication. Ultrasound Med Biol 2013; 39: 1440-1450. – reference: 6)Azuma T, Kawabata K, Umemura S, et al.: Bubble Generation by Standing Wave in Water Surrounded by Cranium with Transcranial Ultrasonic Beam. Jpn J Appl Phys 2005; 44: 4625-4630. – reference: 1)Zinkstok SM, Roos YB, ARTIS investigators: Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial. Lancet 2012; 380: 731-737. – reference: 3)澤口能一，王作軍，古幡博: 超音波は血栓成長を抑制する―塞栓成長抑制・再閉塞予防の可能性―. J Med Ultrasonic 2011; 38: 549-555. – reference: 2)Graham GD: Tissue plasminogen activator for acute ischemic stroke in clinical practice: a meta-analysis of safety data. Stroke 2003; 34: 2847-2850. – reference: 4)Alexandrov AV, Molina CA, Grotta JC, et al.: Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 2004; 351: 2170-2178. – reference: 8)Barreto AD, Alexandrov AV, Lyden P, et al.: The argatroban and tissue-type plasminogen activator stroke study: final results of a pilot safety study. Stroke 2012; 43: 770-775. |
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| SubjectTerms | Blood clots Blood plasma Continuous radiation In vitro methods and tests Irradiation Latex non-invasive ultrasound Occlusion Plasma Plasmas (physics) prevention reocclusion rt-PA Therapy Thrombin |
| Title | 超音波による血管閉塞予防法開発のための基礎的検討 |
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