中大脳動脈塞栓症に対する局所線溶療法

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  • Local intraarterial fibrinolysis for acute embolic middle cerebral artery occlusion.

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Purpose : To evaluate superselective local intraarterial fibrinolysis (LIF) using tPA for acute embolic middle cerebral artery (MCA) occlusion, 77 patients receiving LIF were investigated. Methods : The indication of this treatment includes : 1) within 6 hours after onset of symptoms, 2) no responsible lesions in CT findings, 3) less than 75-year-old. HMPAO SPECT was carried out, if possible. The supplementary indication in SPECT findings is : 4) residual flow in affected side is between 35 and 70% comparing contralateral side. Diagnostic angiography was followed by LIF. Microcatheter was introduced in or beyond the embolus and tisokinase was infused with a maximum amount of 4.8 million LU..<BR>Results : Recanalization was achieved in 73 cases (95%). The intervals from onset to admission, and recanalization are 2.4 hrs, and 5.5 hrs in average, respectively. NIHSS improved 4 points or more in 26 comparing the scores on admission and in the next day. 57% of the patients showed Modified Rankin Scale 3 or better. The cause of the mortality was diffuse hemorrhagic transformation in all 3 cases.<BR>Conclusions : Superselective LIF for acute embolic MCA occlusion is excellent treatment because it carries high recanalization ratio and good clinical outcome.

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  • 脳卒中

    脳卒中 22 (4), 520-523, 2000

    一般社団法人 日本脳卒中学会

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