脳主幹動脈閉塞に対する急性期治療の現状と今後の課題  [in Japanese] Recanalization rate and clinical outcome of intravenous tissue plasminogen activator at 0.6mg/kg and intra-arterial urokinase in acute ischemic stroke with large vessel occlusion  [in Japanese]

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Abstract

脳主幹動脈急性閉塞に対するt-PA静注療法(以下t-PA)および超選択的血栓溶解療法(以下PTA)の再開通の有無,症候性出血の頻度,および3カ月後のmRSを比較し,急性期治療の現状および今後の課題について検討した.対象はt-PA 45症例,PTA 96症例.t-PAとPTAを比較すると,全体の再開通率は35.6%対21.9%,部位別では,中大脳動脈遠位部50.0%対16.7%,中大脳動脈近位部52.6%対25.0%,内頚動脈6.3%対5.3%,脳底動脈25.0%対26.3%.症候性頭蓋内出血0%対5.2%.3カ月後のmRS0,1群は17.4%対12.5%,2,3群は15.3%対14.6%,4,5群は54.3%対47.9%,6群は13%対25%.以上よりt-PA静注療法は,従来の血管内治療に比べ,中大脳動脈閉塞に対する再開通率が良好で,全体の成績向上に貢献した.しかし,内頚動脈や脳底動脈閉塞では両群とも再開通率が不良であり,今後治療の改善や工夫が望まれる.<br>

We evaluated the recanalization rate and clinical outcome of intravenous tissue plasminogen activator (t-PA) and intra-arterial urokinase (PTA) in acute ischemic stroke with large vessel occlusion. The recanalization of the occlusion site and the ischemic change were evaluated with pre-and post-treated MRI and MRA. Total recanalization rates after the IV t-PA and the PTA therapy were 35.6 and 21.9%, respectively. These rates were 50.0 and 16.7% in the distal middle cerebral artery (MCA), 52.6 and 25.0% in the proximal MCA, 6.3 and 5.3% in the internal carotid artery (ICA), 25.0 and 26.3% in the basilar artery (BA), respectively. The rates of the symptomatic intracerebral hemorrhage after IV t-PA and PTA were 0 and 5.2%, respectively. The proportion of modified Rankin Scale (mRS) of 0 to 1 at 3 months after treatments were 17.4% in IV t-PA and 12.5% in PTA. Our results indicated better recanalization rate and outcome of MCA with t-PA than that of PTA. However, the recanalization rate of ICA and BA were very poor in both tPA and PTA as yet. It is necessary to investigate newly strategies and/or modality for ICA and BA occlusion.<br>

Journal

  • Nosotchu

    Nosotchu 30(6), 915-919, 2008-11-25

    The Japan Stroke Society

References:  9

Codes

  • NII Article ID (NAID)
    10024937454
  • NII NACSIS-CAT ID (NCID)
    AN0020186X
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    09120726
  • Data Source
    CJP  J-STAGE 
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