2017 年 11 巻 10 号 p. 504-511
Objective: The objective of this study was to clarify the current status of endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in Japan.
Methods: A questionnaire was sent to members of the Japanese Society for Neuroendovascular Therapy (JSNET) by email, and the answers were collected.
Results: A questionnaire was sent to 1324 facilities, and answers were obtained from 159 (response rate: 12%). There were areas in which endovascular treatment (EVT) was impossible in almost all the prefectures. The mean number of endovascular thrombectomy procedures per facility was 14.1 ± 12.2 per year, and the initial imaging examination was CT at 81% and MRI at 91% of the facilities. Concerning the patients for whom EVT is recommended by the American Heart Association (AHA) guidelines, 119 facilities (76%) answered that all patients were treated by EVT. The baseline Alberta Stroke Program Early CT score (ASPECTS) of ≥6 was considered as an indication for EVT at 45%, and ≥5 at 22% of the facilities. The mean time from hospital arrival (door) to reperfusion was 174.3 ± 63.2 min, and that from arterial puncture to reperfusion was 71.8 ± 26.3 min. The successful reperfusion rate was 75% ± 14% (Thrombolysis in cerebral infarction [TICI] ≥2b) and 45% ± 15% (TICI = 3).
Conclusion: In acute stroke treatment for large vessel occlusion in Japan, MRI was performed as the initial imaging examination at about 90% of the facilities, the number of patients treated per facility was relatively small, and the time to reperfusion, particularly that from arterial puncture to reperfusion, was long. For the future, development of the diagnosis and treatment system for endovascular thrombectomy and approaches to shorten the time to reperfusion are necessary to improve neurologic outcome in EVT.