急性脳血管閉塞症例に対する血管内治療─血栓回収療法導入前後での比較

「はじめに」脳梗塞急性期の治療は, 脳卒中ガイドラインの作成, 薬剤や治療機器の開発により, めざましく進歩している. 日本では2005年10月からrecombinant tissue-plasminogen activator(rt-PA:アルテプラーゼ)静注療法が認可され, 禁忌項目を有さない発症4.5時間以内の脳梗塞患者に対する標準的治療となっている. 一方で, 血管内治療は発症6時間以内の中大脳動脈閉塞症例に対する局所線溶療法の有効性が報告され, 脳血管拡張用バルーンを用いた血管形成, 血栓破砕を組み合わせて行うようになった. 経皮的経管的脳血栓回収療法はMerci Retrieval...

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Published in脳卒中の外科 Vol. 44; no. 1; pp. 43 - 48
Main Authors 関, 行雄, 両角, 佐織, 辻河, 高陽, 安井, 敬三, 長谷川, 康博, 小島, 隆生, 遠藤, 邦幸
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本脳卒中の外科学会 2016
日本脳卒中の外科学会
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ISSN0914-5508
1880-4683
DOI10.2335/scs.44.43

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Abstract 「はじめに」脳梗塞急性期の治療は, 脳卒中ガイドラインの作成, 薬剤や治療機器の開発により, めざましく進歩している. 日本では2005年10月からrecombinant tissue-plasminogen activator(rt-PA:アルテプラーゼ)静注療法が認可され, 禁忌項目を有さない発症4.5時間以内の脳梗塞患者に対する標準的治療となっている. 一方で, 血管内治療は発症6時間以内の中大脳動脈閉塞症例に対する局所線溶療法の有効性が報告され, 脳血管拡張用バルーンを用いた血管形成, 血栓破砕を組み合わせて行うようになった. 経皮的経管的脳血栓回収療法はMerci Retrieval System(Concentric Medical社)およびPenumbra System(Penumbra社)が開発され, 発症8時間以内の内頚動脈, 中大脳動脈, 椎骨動脈, 脳底動脈の閉塞症例のうち, rt-PA静注療法の適応外またはrt-PA静注療法で血流再開が得られなかった症例を対象に, 日本では2010年10月に保険収載され現在広く行われている.
AbstractList 「はじめに」脳梗塞急性期の治療は, 脳卒中ガイドラインの作成, 薬剤や治療機器の開発により, めざましく進歩している. 日本では2005年10月からrecombinant tissue-plasminogen activator(rt-PA:アルテプラーゼ)静注療法が認可され, 禁忌項目を有さない発症4.5時間以内の脳梗塞患者に対する標準的治療となっている. 一方で, 血管内治療は発症6時間以内の中大脳動脈閉塞症例に対する局所線溶療法の有効性が報告され, 脳血管拡張用バルーンを用いた血管形成, 血栓破砕を組み合わせて行うようになった. 経皮的経管的脳血栓回収療法はMerci Retrieval System(Concentric Medical社)およびPenumbra System(Penumbra社)が開発され, 発症8時間以内の内頚動脈, 中大脳動脈, 椎骨動脈, 脳底動脈の閉塞症例のうち, rt-PA静注療法の適応外またはrt-PA静注療法で血流再開が得られなかった症例を対象に, 日本では2010年10月に保険収載され現在広く行われている.
Author 関, 行雄
小島, 隆生
辻河, 高陽
遠藤, 邦幸
両角, 佐織
安井, 敬三
長谷川, 康博
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References 2) Ciccone A, Valvassori L, Nichelatti M, et al : Endovascular treatment for acute ischemic stroke. N Engl J Med 368: 904-913, 2013
14) 日本脳卒中学会脳卒中医療向上・社会保険委員会rt-PA(アルテプラーゼ)静注療法指針改訂部会: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: 441-480, 2012
18) Shi ZS, Liebeskind DS, Xiang B, et al : Predictors of functional dependence despite successful revascularization in largevessel occlusion strokes. Stroke 45: 1977-1984, 2014
20) Smith WS, Sung G, Starkman S, et al : Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36: 1432-1438, 2005
7) Hirano T, Sasaki M, Mori E, et al : Residual vessel length on magnetic resonance angiography identifies poor responders to alteplase in acute middle cerebral artery occlusion patients: exploratory analysis of the Japan Alteplase Clinical Trial II. Stroke 41: 2828-2833, 2010
3) De Silva DA, Brekenfeld C, Ebinger M, et al : The benefits of intravenous thrombolysis relate to the site of baseline arterial occlusion in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Stroke 41: 295-299, 2010
8) Kim YS, Garami Z, Mikulik R, et al : Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke 36: 869-871, 2005
11) Marks MP, Olivot JM, Kemp S, et al : Patients with acute stroke treated with intravenous tPA 3-6 hours after stroke onset: correlations between MR angiography findings and perfusion-and diffusion-weighted imaging in the DEFUSE study. Radiology 249: 614-623, 2008
9) Lees KR, Bluhmki E, von Kummer R, et al : Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPI-THET trials. Lancet 375: 1695-1703, 2010
17) Saver JL, Jahan R, Levy EI, et al : Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380: 1241-1249, 2012
24) Yoshimura S, Sakai N, Okada Y, et al : Efficacy of endovascular treatment for acute cerebral large-vessel occlusion: analysis of nationwide prospective registry. J Stroke Cerebrovasc Dis 23: 1183-1190, 2014
6) Hayakawa M, Yamagami H, Sakai N, et al : Endovascular treatment of acute stroke with major vessel occlusion before approval of mechanical thrombectomy devices in Japan: Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET 2. Neurol Med Chir (Tokyo) 54: 23-31, 2014
21) The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group : Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333: 1581-1587, 1995
4) Furlan A, Higashida R, Wechsler L, et al : Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282: 2003-2011, 1999
10) Linfante I, Llinas RH, Selim M, et al : Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator. Stroke 33: 2066-2071, 2002
5) Hacke W, Kaste M, Bluhmki E, et al : Thrombolysis with alSurgery for Cerebral Stroke 44: 2016 47 teplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359: 1317-1329, 2008
19) Smith WS, Sung G, Saver J, et al : Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39: 1205-1212, 2008
22) The 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: 2761-2768, 2009
1) Broderick JP, Palesch YY, Demchuk AM, et al : Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368: 893-903, 2013
12) Mazighi M, Chaudhry SA, Ribo M, et al : Impact of onset-to-reperfusion time on stroke mortality: a collaborative pooled analysis. Circulation 127: 1980-1985, 2013
16) Ogawa A, Mori E, Minematsu K, et al : Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke 38: 2633-2639, 2007
23) Yamaguchi T, Mori E, Minematsu K, et al : Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT). Stroke 37: 1810-1815, 2006
15) Nogueira RG, Lutsep HL, Gupta R, et al : Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380: 1231-1240, 2012
13) Nakashima T, Toyoda K, Koga M, et al : Arterial occlusion sites on magnetic resonance angiography influence the efficacy of intravenous low-dose (0.6 mg/kg) alteplase therapy for ischaemic stroke. Int J Stroke 4: 425-431, 2009
References_xml – reference: 18) Shi ZS, Liebeskind DS, Xiang B, et al : Predictors of functional dependence despite successful revascularization in largevessel occlusion strokes. Stroke 45: 1977-1984, 2014
– reference: 6) Hayakawa M, Yamagami H, Sakai N, et al : Endovascular treatment of acute stroke with major vessel occlusion before approval of mechanical thrombectomy devices in Japan: Japanese Registry of Neuroendovascular Therapy (JR-NET) and JR-NET 2. Neurol Med Chir (Tokyo) 54: 23-31, 2014
– reference: 10) Linfante I, Llinas RH, Selim M, et al : Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator. Stroke 33: 2066-2071, 2002
– reference: 13) Nakashima T, Toyoda K, Koga M, et al : Arterial occlusion sites on magnetic resonance angiography influence the efficacy of intravenous low-dose (0.6 mg/kg) alteplase therapy for ischaemic stroke. Int J Stroke 4: 425-431, 2009
– reference: 19) Smith WS, Sung G, Saver J, et al : Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke 39: 1205-1212, 2008
– reference: 17) Saver JL, Jahan R, Levy EI, et al : Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 380: 1241-1249, 2012
– reference: 24) Yoshimura S, Sakai N, Okada Y, et al : Efficacy of endovascular treatment for acute cerebral large-vessel occlusion: analysis of nationwide prospective registry. J Stroke Cerebrovasc Dis 23: 1183-1190, 2014
– reference: 21) The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group : Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333: 1581-1587, 1995
– reference: 12) Mazighi M, Chaudhry SA, Ribo M, et al : Impact of onset-to-reperfusion time on stroke mortality: a collaborative pooled analysis. Circulation 127: 1980-1985, 2013
– reference: 14) 日本脳卒中学会脳卒中医療向上・社会保険委員会rt-PA(アルテプラーゼ)静注療法指針改訂部会: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: 441-480, 2012
– reference: 9) Lees KR, Bluhmki E, von Kummer R, et al : Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPI-THET trials. Lancet 375: 1695-1703, 2010
– reference: 2) Ciccone A, Valvassori L, Nichelatti M, et al : Endovascular treatment for acute ischemic stroke. N Engl J Med 368: 904-913, 2013
– reference: 4) Furlan A, Higashida R, Wechsler L, et al : Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282: 2003-2011, 1999
– reference: 3) De Silva DA, Brekenfeld C, Ebinger M, et al : The benefits of intravenous thrombolysis relate to the site of baseline arterial occlusion in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Stroke 41: 295-299, 2010
– reference: 5) Hacke W, Kaste M, Bluhmki E, et al : Thrombolysis with alSurgery for Cerebral Stroke 44: 2016 47 teplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359: 1317-1329, 2008
– reference: 1) Broderick JP, Palesch YY, Demchuk AM, et al : Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 368: 893-903, 2013
– reference: 11) Marks MP, Olivot JM, Kemp S, et al : Patients with acute stroke treated with intravenous tPA 3-6 hours after stroke onset: correlations between MR angiography findings and perfusion-and diffusion-weighted imaging in the DEFUSE study. Radiology 249: 614-623, 2008
– reference: 20) Smith WS, Sung G, Starkman S, et al : Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36: 1432-1438, 2005
– reference: 23) Yamaguchi T, Mori E, Minematsu K, et al : Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT). Stroke 37: 1810-1815, 2006
– reference: 15) Nogueira RG, Lutsep HL, Gupta R, et al : Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 380: 1231-1240, 2012
– reference: 22) The 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: 2761-2768, 2009
– reference: 16) Ogawa A, Mori E, Minematsu K, et al : Randomized trial of intraarterial infusion of urokinase within 6 hours of middle cerebral artery stroke: the middle cerebral artery embolism local fibrinolytic intervention trial (MELT) Japan. Stroke 38: 2633-2639, 2007
– reference: 7) Hirano T, Sasaki M, Mori E, et al : Residual vessel length on magnetic resonance angiography identifies poor responders to alteplase in acute middle cerebral artery occlusion patients: exploratory analysis of the Japan Alteplase Clinical Trial II. Stroke 41: 2828-2833, 2010
– reference: 8) Kim YS, Garami Z, Mikulik R, et al : Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke 36: 869-871, 2005
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Snippet 「はじめに」脳梗塞急性期の治療は, 脳卒中ガイドラインの作成, 薬剤や治療機器の開発により, めざましく進歩している. 日本では2005年10月からrecombinant...
SourceID medicalonline
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SourceType Publisher
StartPage 43
SubjectTerms acute ischemic stroke
endovascular treatment
mechanical thrombectomy
Title 急性脳血管閉塞症例に対する血管内治療─血栓回収療法導入前後での比較
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