rt-PA療法の今後の展望 : 血管内治療医の立場から Prospects of intravenous rt-PA for acute stroke from a standpoint of neuroendovascular therapeutist
Intravenous rt-PA for acute cerebral infarction was approved in October 2005. This approval influences also our neuroendovascular therapeutists. The largest one was an influence to MELT Japan. The safety committee of MELT Japan recommended to stop recruitment after approval of intravenous rt-PA. The principal reason was: there is ethical problem in enrolling the patient indicating intravenous rt-PA to MELT Japan in-stead of doing intravenous rt-PA. So, MELT Japan was interrupted simultaneously with the approval of intra-venous rt-PA. The total number registered to MELT Japan was 114 cases, 57 cases each for fibrinolysis group and control group. Primary endpoint (modified Rankin Scales 0 to 2) was observed in 28 cases in fibrinolysis group while 22 cases in control group, though this is not statistically different. Modified Rankin Scales 0 to 1, one of the secondary endopoints, was observed 24 cases in fibrinolysis group and 13 cases in control group (p<0.05). Although the first choice for acute cerebral infarction is intravenous rt-PA, intravenous rt-PA has not so strong effect. Combined treatment with intraarterial rt-PA and/or PTA should be considered in the era of intravenous rt-PA.
脳卒中 28(4), 673-676, 2006-12-25
The Japan Stroke Society