アブストラクト
| Title | 3 急性期脳梗塞治療 |
|---|---|
| Subtitle | 特集 脳卒中リハビリテーション医療アップデート |
| Authors | 坂本悠記*, 木村和美* |
| Authors (kana) | |
| Organization | *日本医科大学脳神経内科 |
| Journal | The Japanese Journal of Rehabilitation Medicine |
| Volume | 61 |
| Number | 2 |
| Page | 91-95 |
| Year/Month | 2024 / 2 |
| Article | 報告 |
| Publisher | 日本リハビリテーション医学会 |
| Abstract | 「要旨」本稿では, 主に超急性期〜急性期脳梗塞の治療に関して述べる. まず, 発症から4.5時間以内である脳梗塞患者にはrt-PA静注療法を考慮し, 発症から6時間以内の脳主幹動脈閉塞を有する脳梗塞患者には血栓回収療法を考慮する. rt-PA静注療法に関しては発症時間不明例においてMRI画像を利用して適応判定を行うことができ, 血栓回収療法に関しては近年, 発症から時間の経過した症例, 脳梗塞が広範に認められている症例などに対する適応拡大がなされている. rt-PA静注療法や血栓回収療法の終了後, またはそれらの適応のない患者に対しては, 脳梗塞の原因や病態に応じて抗凝固療法や抗血小板療法が行われる. |
| Practice | 医療技術 |
| Keywords | recombinant tissue-plasminogen activator, 血栓回収療法, 抗凝固療法, 抗血小板療法 |
- 全文ダウンロード： 従量制、基本料金制の方共に770円(税込) です。
参考文献
- 1) 日本脳卒中学会脳卒中医療向上・社会保険委員会, 静注血栓溶解療法指針改訂部会 : 静注血栓溶解(rt-PA)療法 適正治療指針 第三版, 2019. Availa-ble from URL : https://www.jsts.gr.jp/img/rt-PA03.pdf
- 2) Emberson J, Lees KR, Lyden P, et al : Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke : a meta-analysis of indi-vidual patient data from randomised trials. Lancet 2014 ; 384 : 1929-1935
- 3) Sakamoto Y, Tanabe M, Masuda K, et al : Feasibili-ty of using magnetic resonance imaging as a screen-ing tool for acute stroke thrombolysis. J Neurol Sci 2016 ; 368 : 168-172
- 4) Fink JN, Kumar S, Horkan C, et al : The stroke pa-tient who woke up : clinical and radiological fea-tures, including diffusion and perfusion MRI. Stroke 2002 ; 33 : 988-993
- 5) Aoki J, Kimura K, Iguchi Y, Shibazaki K, Sakai K, Iwanaga T : FLAIR can estimate the onset time in acute ischemic stroke patients. J Neurol Sci 2010 ; 293 : 39-44
残りの25件を表示する
- 6) Thomalla G, Cheng B, Ebinger M, et al : DWI-FLAIR mismatch for the identification of patients with acute ischaemic stroke within 4.5h of symp-tom onset(PRE-FLAIR) : a multicentre observa-tional study. Lancet Neurol 2011 ; 10 : 978-986
- 7) Koga M, Yamamoto H, Inoue M, et al : Thromboly-sis With Alteplase at 0.6 mg/kg for Stroke With Unknown Time of Onset : A Randomized Control-led Trial. Stroke 2020 ; 51 : 1530-1538
- 8) Thomalla G, Simonsen CZ, Boutitie F, et al : MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med 2018 ; 379 : 611-622
- 9) Campbell BCV, Mitchell PJ, Churilov L, et al : Ten-ecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med 2018 ; 378 : 1573-1582
- 10) Warach SJ, Ranta A, Kim J, et al : Symptomatic In-tracranial Hemorrhage With Tenecteplase vs Alte-plase in Patients With Acute Ischemic Stroke : The Comparative Effectiveness of Routine Tenecteplase vs Alteplase in Acute Ischemic Stroke(CERTAIN) Collaboration. JAMA Neurol 2023 ; 80 : 732-738
- 11) Kawano H, Hirano T, Inoue M, et al : Tenecteplase versus alteplase for large vessel occlusion recanali-zation(T-FLAVOR) : Trial protocol. Eur Stroke J 2022 ; 7 : 71-75
- 12) Berkhemer OA, Fransen PS, Beumer D, et al : A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015 ; 372 : 11-20
- 13) Campbell BC, Mitchell PJ, Kleinig TJ, et al : Endo-vascular therapy for ischemic stroke with perfu-sion-imaging selection. N Engl J Med 2015 ; 372 : 1009-1018
- 14) Goyal M, Demchuk AM, Menon BK, et al : Random-ized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015 ; 372 : 1019-1030
- 15) Jovin TG, Chamorro A, Cobo E, et al : Thrombecto-my within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015 ; 372 : 2296-2306
- 16) Saver JL, Goyal M, Bonafe A, et al : Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015 ; 372 : 2285-2295
- 17) 日本脳卒中学会脳卒中ガイドライン委員会 編 : 脳卒中治療ガイドライン 2021. 協和企画, 東京, 2021
- 18) Saver JL, Goyal M, van der Lugt A, et al : Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke : A Meta-analysis. JAMA 2016 ; 316 : 1279-1288
- 19) Sakamoto Y, Suzuki K, Abe A, et al : Reducing door-to-reperfusion time in acute stroke endovascular therapy using magnetic resonance imaging as a screening modality. J Neurointerv Surg 2020 ; 12 : 1080-1084
- 20) Jovin TG, Li C, Wu L, et al : Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med 2022 ; 387 : 1373-1384
- 21) Tao C, Nogueira RG, Zhu Y, et al : Trial of Endo-vascular Treatment of Acute Basilar-Artery Occlu-sion. N Engl J Med 2022 ; 387 : 1361-1372
- 22) Yoshimura S, Sakai N, Yamagami H, et al : Endo-vascular Therapy for Acute Stroke with a Large Ischemic Region. N Engl J Med 2022 ; 386 : 1303-1313
- 23) Huo X, Ma G, Tong X, et al : Trial of Endovascular Therapy for Acute Ischemic Stroke with Large Infarct. N Engl J Med 2023 ; 388 : 1272-1283
- 24) Sarraj A, Hassan AE, Abraham MG, et al : Trial of Endovascular Thrombectomy for Large Ischemic Strokes. N Engl J Med 2023 ; 388 : 1259-1271
- 25) Albers GW, Marks MP, Kemp S, et al : Thrombec-tomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med 2018 ; 378 : 708-718
- 26) Nogueira RG, Jadhav AP, Haussen DC, et al : Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018 ; 378 : 11-21
- 27) Toyoda K, Yasaka M, Iwade K, et al : Dual antith-rombotic therapy increases severe bleeding eventsin patients with stroke and cardiovascular disease : a prospective, multicenter, observational study. Stroke 2008 ; 39 : 1740-1745
- 28) Toyoda K, Yasaka M, Uchiyama S, et al : Blood pres-sure levels and bleeding events during antithrom-botic therapy : the Bleeding with Antithrombotic Therapy(BAT) Study. Stroke 2010 ; 41 : 1440-1444
- 29) Wang Y, Wang Y, Zhao X, et al : Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013 ; 369 : 11-19
- 30) Johnston SC, Easton JD, Farrant M, et al : Clopidog-rel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. N Engl J Med 2018 ; 379 : 215-225
