頭蓋内主幹動脈閉塞に頸部内頸動脈病変を伴う tandem lesions に対し，血栓回収療法と血行再建術を併用した症例についての検討
要旨：頭蓋内主幹動脈閉塞に頸部内頸動脈狭窄もしくは閉塞を伴う tandem lesions を有する急性期脳梗塞に対し，早期再灌流最優先の方針で加療した rt-PA 非投与の自験5例をもとに，その治療戦略について検討した．頸動脈狭窄が高度で血栓回収とCASを一期的に併用した3症例については，血栓吸引カテーテルが近位部病変を通過困難な1例ではCASを先行し，通過可能な2例では血栓回収先行後，CASを追加した．全例で良好な再開通が得られたが，1例でステント内血栓症を合併した．ステント留置による過凝固傾向を惹起した可能性があった．頸動脈中等度狭窄で術中狭窄の進行がない2例では，CEAによる二期的血行...
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| Published in | 脳卒中 Vol. 43; no. 2; pp. 158 - 166 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中学会
2021
日本脳卒中学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0912-0726 1883-1923 |
| DOI | 10.3995/jstroke.10786 |
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| Abstract | 要旨：頭蓋内主幹動脈閉塞に頸部内頸動脈狭窄もしくは閉塞を伴う tandem lesions を有する急性期脳梗塞に対し，早期再灌流最優先の方針で加療した rt-PA 非投与の自験5例をもとに，その治療戦略について検討した．頸動脈狭窄が高度で血栓回収とCASを一期的に併用した3症例については，血栓吸引カテーテルが近位部病変を通過困難な1例ではCASを先行し，通過可能な2例では血栓回収先行後，CASを追加した．全例で良好な再開通が得られたが，1例でステント内血栓症を合併した．ステント留置による過凝固傾向を惹起した可能性があった．頸動脈中等度狭窄で術中狭窄の進行がない2例では，CEAによる二期的血行再建術を選択したが，web状狭窄を伴った1例に脳梗塞の再発が生じた．中等度狭窄であっても可及的早期の CAS/CEA を検討すべきである． |
|---|---|
| AbstractList | 「要旨」 : 頭蓋内主幹動脈閉塞に頸部内頸動脈狭窄もしくは閉塞を伴うtandem lesionsを有する急性期脳梗塞に対し, 早期再灌流最優先の方針で加療したrt-PA非投与の自験5例をもとに, その治療戦略について検討した. 頸動脈狭窄が高度で血栓回収とCASを一期的に併用した3症例については, 血栓吸引カテーテルが近位部病変を通過困難な1例ではCASを先行し, 通過可能な2例では血栓回収先行後, CASを追加した. 全例で良好な再開通が得られたが, 1例でステント内血栓症を合併した. ステント留置による過凝固傾向を惹起した可能性があった. 頸動脈中等度狭窄で術中狭窄の進行がない2例では, CEAによる二期的血行再建術を選択したが, web状狭窄を伴った1例に脳梗塞の再発が生じた. 中等度狭窄であっても可及的早期のCAS/CEAを検討すべきである. 要旨：頭蓋内主幹動脈閉塞に頸部内頸動脈狭窄もしくは閉塞を伴う tandem lesions を有する急性期脳梗塞に対し，早期再灌流最優先の方針で加療した rt-PA 非投与の自験5例をもとに，その治療戦略について検討した．頸動脈狭窄が高度で血栓回収とCASを一期的に併用した3症例については，血栓吸引カテーテルが近位部病変を通過困難な1例ではCASを先行し，通過可能な2例では血栓回収先行後，CASを追加した．全例で良好な再開通が得られたが，1例でステント内血栓症を合併した．ステント留置による過凝固傾向を惹起した可能性があった．頸動脈中等度狭窄で術中狭窄の進行がない2例では，CEAによる二期的血行再建術を選択したが，web状狭窄を伴った1例に脳梗塞の再発が生じた．中等度狭窄であっても可及的早期の CAS/CEA を検討すべきである． |
| Author | 小野, 智憲 日宇, 健 松尾, 彩香 原口, 渉 大塚, 寛朗 堤, 圭介 川原, 一郎 岩永, 洋 牛島, 隆二郎 近松, 元気 |
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| References | 1) Rubiera M, Ribo M, Delgado-Mederos R, et al: Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke 37: 2301–2305, 2006 13) Behme D, Mpotsaris A, Zeyen P, et al: Emergency stenting of the extracranial internal carotid artery in combination with anterior circulation thrombectomy in acute ischemic stroke: a retrospective multicenter study. AJNR Am J Neuroradiol 36: 2340–2345, 2015 15) Kernan WN, Ovbiagele B, Black HR, et al: Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45: 2160–2236, 2014 7) Stampfl S, Ringleb PA, Möhlenbruch M, et al: Emergency cervical internal carotid artery stenting in combination with intracranial thrombectomy in acute stroke. AJNR Am J Neuroradiol 35: 741–746, 2014 14) Rubartelli P, Brusa G, Arrigo A, et al: Transcranial Doppler monitoring during stenting of the carotid bifurcation: evaluation of two different distal protection devices in preventing embolization. J Endovasc Ther 13: 436–442, 2006 8) Dorado L, Castaño C, Millán M, et al: Hemorrhagic risk of emergent endovascular treatment plus stenting in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 22: 1326–1331, 2013 3) Goyal M, Demchuk AM, Menon BK, et al: Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372: 1019–1030, 2015 9) Zhu F, Bracard S, Anxionnat R, et al: Impact of emergent cervical carotid stenting in tandem occlusion strokes treated by thrombectomy: a review of the TITAN collaboration. Front Neurol 10: 206, 2019 11) Rangel-Castilla L, Rajah GB, Shakir HJ, et al: Management of acute ischemic stroke due to tandem occlusion: should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first? Neurosurg Focus 42: E16, 2017 16) Haussen DC, Grossberg JA, Bouslama M, et al: Carotid web (intimal fibromuscular dysplasia) has high stroke recurrence risk and is amenable to stenting. Stroke 48: 3134–3137, 2017 12) New G, Roubin GS, Iyer SS, et al: Carotid artery stenting: rationale, indications, and results. Compr Ther 25: 438–445, 1999 6) Lockau H, Liebig T, Henning T, et al: Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results. Neuroradiology 57: 589–598, 2015 2) Berkhemer OA, Fransen PS, Beumer D, et al: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372: 11–20, 2015 5) Jovin TG, Chamorro A, Cobo E, et al: Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372: 2296–2306, 2015 10) Jacquin G, Poppe AY, Labrie M, et al: Lack of consensus among stroke experts on the optimal management of patients with acute tandem occlusion. Stroke 50: 1254–1256, 2019 4) Campbell BC, Mitchell PJ, Kleinig TJ, et al: Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372: 1009–1018, 2015 |
| References_xml | – reference: 4) Campbell BC, Mitchell PJ, Kleinig TJ, et al: Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 372: 1009–1018, 2015 – reference: 3) Goyal M, Demchuk AM, Menon BK, et al: Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 372: 1019–1030, 2015 – reference: 8) Dorado L, Castaño C, Millán M, et al: Hemorrhagic risk of emergent endovascular treatment plus stenting in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 22: 1326–1331, 2013 – reference: 7) Stampfl S, Ringleb PA, Möhlenbruch M, et al: Emergency cervical internal carotid artery stenting in combination with intracranial thrombectomy in acute stroke. AJNR Am J Neuroradiol 35: 741–746, 2014 – reference: 1) Rubiera M, Ribo M, Delgado-Mederos R, et al: Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke 37: 2301–2305, 2006 – reference: 2) Berkhemer OA, Fransen PS, Beumer D, et al: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372: 11–20, 2015 – reference: 9) Zhu F, Bracard S, Anxionnat R, et al: Impact of emergent cervical carotid stenting in tandem occlusion strokes treated by thrombectomy: a review of the TITAN collaboration. Front Neurol 10: 206, 2019 – reference: 11) Rangel-Castilla L, Rajah GB, Shakir HJ, et al: Management of acute ischemic stroke due to tandem occlusion: should endovascular recanalization of the extracranial or intracranial occlusive lesion be done first? Neurosurg Focus 42: E16, 2017 – reference: 6) Lockau H, Liebig T, Henning T, et al: Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results. Neuroradiology 57: 589–598, 2015 – reference: 12) New G, Roubin GS, Iyer SS, et al: Carotid artery stenting: rationale, indications, and results. Compr Ther 25: 438–445, 1999 – reference: 16) Haussen DC, Grossberg JA, Bouslama M, et al: Carotid web (intimal fibromuscular dysplasia) has high stroke recurrence risk and is amenable to stenting. Stroke 48: 3134–3137, 2017 – reference: 14) Rubartelli P, Brusa G, Arrigo A, et al: Transcranial Doppler monitoring during stenting of the carotid bifurcation: evaluation of two different distal protection devices in preventing embolization. J Endovasc Ther 13: 436–442, 2006 – reference: 15) Kernan WN, Ovbiagele B, Black HR, et al: Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45: 2160–2236, 2014 – reference: 5) Jovin TG, Chamorro A, Cobo E, et al: Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372: 2296–2306, 2015 – reference: 13) Behme D, Mpotsaris A, Zeyen P, et al: Emergency stenting of the extracranial internal carotid artery in combination with anterior circulation thrombectomy in acute ischemic stroke: a retrospective multicenter study. AJNR Am J Neuroradiol 36: 2340–2345, 2015 – reference: 10) Jacquin G, Poppe AY, Labrie M, et al: Lack of consensus among stroke experts on the optimal management of patients with acute tandem occlusion. Stroke 50: 1254–1256, 2019 |
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| Snippet | 要旨：頭蓋内主幹動脈閉塞に頸部内頸動脈狭窄もしくは閉塞を伴う tandem lesions を有する急性期脳梗塞に対し，早期再灌流最優先の方針で加療した rt-PA 非投与の自験5... 「要旨」 : 頭蓋内主幹動脈閉塞に頸部内頸動脈狭窄もしくは閉塞を伴うtandem lesionsを有する急性期脳梗塞に対し, 早期再灌流最優先の方針で加療したrt-PA非投与の自験5... |
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| SubjectTerms | cervical internal carotid artery stenosis emergency carotid artery stenting stent thrombosis tandem lesions thrombectomy |
| Title | 頭蓋内主幹動脈閉塞に頸部内頸動脈病変を伴う tandem lesions に対し，血栓回収療法と血行再建術を併用した症例についての検討 |
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