臨床神経学

第48回日本神経学会総会

<シンポジウム8-4>最新の脳卒中治療
脳梗塞急性期治療―とくにt-PA静注療法とその問題点

長尾 毅彦, 片山 泰朗1), 横地 正之

(財)東京都保健医療公社 荏原病院 総合脳卒中センター〔〒145-0065 東京都大田区東雪谷4-5-10〕
1)日本医科大学 内科(神経・腎臓・膠原病リウマチ部門)

Since October 2005, following government approval for tPA use in acute ischemic stroke, over 5,000 patients have been given intravenous thrombolytic therapy in Japan. According to the newest but incomplete report on post-marketing investigations, whereas the rate of hemorrhagic complications remains the same, the proportion of good outcomes is slightly lower than that in Europe. This may reflect the higher inclusion rate of cardioembolic stroke and severe stroke patients in Japan.
Many important, unresolved problems still exist concerning tPA therapy even in Japan. In particular, improvement of the emergency medical systems which transport acute stroke patients for thrombolysis to the primary stroke center appropriately and rapidly, and the establishment of in-hospital systems for tPA therapy including extensive co-medical staff and neuroradiological equipment, have priority. Moreover, high expectations are held for new stroke MR techniques including "diffusion-perfusion mismatch", combined additional antithrombotic drugs or intra-arterial cathetherization maneuvers, and ultrasound examinations with contrast media, to achieve a more favorable outcome with this therapy.

(臨床神経, 47:926−928, 2007)
key words:血栓溶解療法, diffusion-perfusion mismatch, 脳卒中救急搬送体制, 脳卒中センター

(受付日:2007年5月16日)