機械的血栓回収療法による再開通後の急性脳腫脹の転帰とその関連因子
要旨：【背景および目的】機械的血栓回収療法後に再開通が得られても急性脳腫脹を生じる例をしばしば経験するが，その中には比較的良好な転帰を示す例も存在する．そこで急性脳腫脹の関連因子および転帰への影響について後ろ向きに検討した．【方法】2013～2019 年に本治療を施行した ICA，M1 閉塞で，mTICI 2b 以上の再開通を得た101例を対象とし，急性脳腫脹を認めた群（急性脳腫脹群：S群）と認めなかった群（非脳腫脹群：N群）で比較検討した．【結果】急性脳腫脹は18例（17.8％）で認められた．S群はN群に比して入院時 NIHSS が高く，DWI-ASPECTS が低値であったが，3カ月後転帰...
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| Published in | 脳卒中 Vol. 43; no. 2; pp. 117 - 123 |
|---|---|
| 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.10784 |
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| Abstract | 要旨：【背景および目的】機械的血栓回収療法後に再開通が得られても急性脳腫脹を生じる例をしばしば経験するが，その中には比較的良好な転帰を示す例も存在する．そこで急性脳腫脹の関連因子および転帰への影響について後ろ向きに検討した．【方法】2013～2019 年に本治療を施行した ICA，M1 閉塞で，mTICI 2b 以上の再開通を得た101例を対象とし，急性脳腫脹を認めた群（急性脳腫脹群：S群）と認めなかった群（非脳腫脹群：N群）で比較検討した．【結果】急性脳腫脹は18例（17.8％）で認められた．S群はN群に比して入院時 NIHSS が高く，DWI-ASPECTS が低値であったが，3カ月後転帰良好の割合に有意差はなかった（27.8％ vs 45.8％）．S群では11例（61.1％）が開頭減圧術を受け，同群のうち5例が転帰良好（mRS≤2）であった．多変量解析では，DWI-ASPECTS 値が急性脳腫脹の出現と関連していた（オッズ比0.55，95％信頼区間0.39–0.72）．【結論】急性脳腫脹を生じても，若年で ASPECT 高値例に開頭外減圧術を行えば良好な転帰が得られる可能性がある． |
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| AbstractList | 「要旨」 : 【背景および目的】機械的血栓回収療法後に再開通が得られても急性脳腫脹を生じる例をしばしば経験するが, その中には比較的良好な転帰を示す例も存在する. そこで急性脳腫脹の関連因子および転帰への影響について後ろ向きに検討した. 【方法】2013～2019年に本治療を施行したICA, M1閉塞で, mTICI 2b以上の再開通を得た101例を対象とし, 急性脳腫脹を認めた群 (急性脳腫脹群 : S群) と認めなかった群 (非脳腫脹群 : N群) で比較検討した. 【結果】急性脳腫脹は18例 (17.8%) で認められた. S群はN群に比して入院時NIHSSが高く, DWI-ASPECTSが低値であったが, 3カ月後転帰良好の割合に有意差はなかった (27.8% vs 45.8%). S群では11例 (61.1%) が開頭減圧術を受け, 同群のうち5例が転帰良好 (mRS≦2) であった. 多変量解析では, DWI-ASPECTS値が急性脳腫脹の出現と関連していた (オッズ比0.55, 95%信頼区間0.39-0.72). 【結論】急性脳腫脹を生じても, 若年でASPECT高値例に開頭外減圧術を行えば良好な転帰が得られる可能性がある. 要旨：【背景および目的】機械的血栓回収療法後に再開通が得られても急性脳腫脹を生じる例をしばしば経験するが，その中には比較的良好な転帰を示す例も存在する．そこで急性脳腫脹の関連因子および転帰への影響について後ろ向きに検討した．【方法】2013～2019 年に本治療を施行した ICA，M1 閉塞で，mTICI 2b 以上の再開通を得た101例を対象とし，急性脳腫脹を認めた群（急性脳腫脹群：S群）と認めなかった群（非脳腫脹群：N群）で比較検討した．【結果】急性脳腫脹は18例（17.8％）で認められた．S群はN群に比して入院時 NIHSS が高く，DWI-ASPECTS が低値であったが，3カ月後転帰良好の割合に有意差はなかった（27.8％ vs 45.8％）．S群では11例（61.1％）が開頭減圧術を受け，同群のうち5例が転帰良好（mRS≤2）であった．多変量解析では，DWI-ASPECTS 値が急性脳腫脹の出現と関連していた（オッズ比0.55，95％信頼区間0.39–0.72）．【結論】急性脳腫脹を生じても，若年で ASPECT 高値例に開頭外減圧術を行えば良好な転帰が得られる可能性がある． |
| Author | 吉田, 泰之 徳山, 承明 吉江, 智秀 大坪, 治喜 高田, 達郎 髙石, 智 長谷川, 泰弘 深野, 崇之 辰野, 健太郎 植田, 敏浩 臼杵, 乃理子 濵田, 祐樹 小野, 元 |
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| References | 20) Thorén M, Azevedo E, Dawson J, et al: Predictors for cerebral edema in acute ischemic stroke treated with intravenous thrombolysis. Stroke 48: 2464–2471, 2017 13) Strbian D, Karjalainen-Lindsberg ML, Kovanen PT, et al: Mast cell stabilization reduces hemorrhage formation and mortality after administration of thrombolytics in experimental ischemic stroke. Circulation 116: 411–418, 2007 1) Wu S, Yuan R, Wang Y, et al: Early prediction of malignant brain edema after ischemic stroke. Stroke 49: 2918–2927, 2018 8) Hofmeijer J, Kappelle LJ, Algra A, et al: Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 8: 326–333, 2009 15) 佐々木貴浩，戸村九月，岡田秀雄ら：中大脳動脈塞栓症に対する血栓回収術後に遅発性白質病変を認めた 1 例．脳卒中 40: 270–274, 2018 21) Ong CJ, Gluckstein J, Laurido-Soto O, et al: Enhanced Detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) score: a risk prediction tool. Stroke 48: 1969–1972, 2017 7) Jüttler E, Schwab S, Schmiedek P, et al: Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke 38: 2518–2525, 2007 14) McCord JM: Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 312: 159–163, 1985 17) Fuhrer H, Schönenberger S, Niesen WD, et al: Endovascular stroke treatment's impact on malignant type of edema (ESTIMATE). J Neurol 266: 223–231, 2019 16) Flores A, Rubiera M, Ribó M, et al: Poor collateral circulation assessed by multiphase computed tomographic angiography predicts malignant middle cerebral artery evolution after reperfusion therapies. Stroke 46: 3149–3153, 2015 24) Jüttler E, Schellinger PD, Aschoff A, et al: Clinical review: Therapy for refractory intracranial hypertension in ischaemic stroke. Crit Care 11: 231, 2007(doi:10.1186/cc6087 2) Adams HP, Bendixen BH, Kappelle LJ, et al: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24: 35–41, 1993 11) 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 4) Hacke W, Schwab S, Horn M, et al: 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53: 309–315, 1996 5) Stokum JA, Gerzanich V, Simard JM: Molecular pathophysiology of cerebral edema. J Cereb Blood Flow Metab 36: 513–538, 2016 18) Shimoyama T, Kimura K, Uemura J, et al: The DASH score: a simple score to assess risk for development of malignant middle cerebral artery infarction. J Neurol Sci 338: 102–106, 2014 6) Vahedi K, Vicaut E, Mateo J, et al: Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 38: 2506–2517, 2007 10) Irvine HJ, Ostwaldt AC, Bevers MB, et al: Reperfusion after ischemic stroke is associated with reduced brain edema. J Cereb Blood Flow Metab 38: 1807–1817, 2018 23) Albert AF, Kirkman MA: Clinical and radiological predictors of malignant middle cerebral artery infarction development and outcomes. J Stroke Cerebrovasc Dis 26: 2671–2679, 2017 19) Thomalla G, Hartmann F, Juettler E, et al: Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational study. Ann Neurol 68: 435–445, 2010 22) Kasner SE, Demchuk AM, Berrouschot J, et al: Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke 32: 2117–2123, 2001 12) 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 3) Kawano H, Hirano T, Nakajima M, et al: Modified ASPECTS for DWI including deep white matter lesions predicts subsequent intracranial hemorrhage. J Neurol 259: 2045–2052, 2012 9) Broocks G, Hanning U, Flottmann F, et al: Clinical benefit of thrombectomy in stroke patients with low ASPECTS is mediated by oedema reduction. Brain 142: 1399–1407, 2019 |
| References_xml | – reference: 5) Stokum JA, Gerzanich V, Simard JM: Molecular pathophysiology of cerebral edema. J Cereb Blood Flow Metab 36: 513–538, 2016 – reference: 14) McCord JM: Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 312: 159–163, 1985 – reference: 8) Hofmeijer J, Kappelle LJ, Algra A, et al: Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 8: 326–333, 2009 – reference: 11) 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: 19) Thomalla G, Hartmann F, Juettler E, et al: Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational study. Ann Neurol 68: 435–445, 2010 – reference: 15) 佐々木貴浩，戸村九月，岡田秀雄ら：中大脳動脈塞栓症に対する血栓回収術後に遅発性白質病変を認めた 1 例．脳卒中 40: 270–274, 2018 – reference: 6) Vahedi K, Vicaut E, Mateo J, et al: Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 38: 2506–2517, 2007 – reference: 18) Shimoyama T, Kimura K, Uemura J, et al: The DASH score: a simple score to assess risk for development of malignant middle cerebral artery infarction. J Neurol Sci 338: 102–106, 2014 – reference: 16) Flores A, Rubiera M, Ribó M, et al: Poor collateral circulation assessed by multiphase computed tomographic angiography predicts malignant middle cerebral artery evolution after reperfusion therapies. Stroke 46: 3149–3153, 2015 – reference: 20) Thorén M, Azevedo E, Dawson J, et al: Predictors for cerebral edema in acute ischemic stroke treated with intravenous thrombolysis. Stroke 48: 2464–2471, 2017 – reference: 1) Wu S, Yuan R, Wang Y, et al: Early prediction of malignant brain edema after ischemic stroke. Stroke 49: 2918–2927, 2018 – reference: 3) Kawano H, Hirano T, Nakajima M, et al: Modified ASPECTS for DWI including deep white matter lesions predicts subsequent intracranial hemorrhage. J Neurol 259: 2045–2052, 2012 – reference: 22) Kasner SE, Demchuk AM, Berrouschot J, et al: Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke 32: 2117–2123, 2001 – reference: 23) Albert AF, Kirkman MA: Clinical and radiological predictors of malignant middle cerebral artery infarction development and outcomes. J Stroke Cerebrovasc Dis 26: 2671–2679, 2017 – reference: 9) Broocks G, Hanning U, Flottmann F, et al: Clinical benefit of thrombectomy in stroke patients with low ASPECTS is mediated by oedema reduction. Brain 142: 1399–1407, 2019 – reference: 12) 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: 21) Ong CJ, Gluckstein J, Laurido-Soto O, et al: Enhanced Detection of Edema in Malignant Anterior Circulation Stroke (EDEMA) score: a risk prediction tool. Stroke 48: 1969–1972, 2017 – reference: 10) Irvine HJ, Ostwaldt AC, Bevers MB, et al: Reperfusion after ischemic stroke is associated with reduced brain edema. J Cereb Blood Flow Metab 38: 1807–1817, 2018 – reference: 4) Hacke W, Schwab S, Horn M, et al: 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53: 309–315, 1996 – reference: 24) Jüttler E, Schellinger PD, Aschoff A, et al: Clinical review: Therapy for refractory intracranial hypertension in ischaemic stroke. Crit Care 11: 231, 2007(doi:10.1186/cc6087) – reference: 7) Jüttler E, Schwab S, Schmiedek P, et al: Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke 38: 2518–2525, 2007 – reference: 13) Strbian D, Karjalainen-Lindsberg ML, Kovanen PT, et al: Mast cell stabilization reduces hemorrhage formation and mortality after administration of thrombolytics in experimental ischemic stroke. Circulation 116: 411–418, 2007 – reference: 2) Adams HP, Bendixen BH, Kappelle LJ, et al: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24: 35–41, 1993 – reference: 17) Fuhrer H, Schönenberger S, Niesen WD, et al: Endovascular stroke treatment's impact on malignant type of edema (ESTIMATE). J Neurol 266: 223–231, 2019 |
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| Snippet | 要旨：【背景および目的】機械的血栓回収療法後に再開通が得られても急性脳腫脹を生じる例をしばしば経験するが，その中には比較的良好な転帰を示す例も存在する．そこで急... 「要旨」 : 【背景および目的】機械的血栓回収療法後に再開通が得られても急性脳腫脹を生じる例をしばしば経験するが, その中には比較的良好な転帰を示す例も存在する. そこで... |
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| Title | 機械的血栓回収療法による再開通後の急性脳腫脹の転帰とその関連因子 |
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| ispartofPNX | 脳卒中, 2021, Vol.43(2), pp.117-123 |
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