特集 神経疾患治療の進歩2015年
脳血管障害の治療の進歩
キーワード:
mechanical thrombectomy,
tissue plasminogen activator (tPA),
control of blood pressure,
silent cerebral infarction
2017 年 33 巻 4 号 p. 502-505
詳細
2017 年 33 巻 4 号 p. 502-505
After the report of 5 major randomized controlled trials (ESCAPE, EXTEND–IA, SWIFT–PRIME, MR–CLEAN, REVASCAT), adding mechanical thrombectomy on the t–PA therapy was thought to be acceptable. Mechanical thrombectomy might come back to the front page of the acute stroke therapy guidline. With the elongation of t–PA therapy to 4.5 h after onset of the ischemic stroke, the new era started for the acute stroke therapy. Although the study showed good results for mechanical thrombectomy, it should be emphasized that those studies were built on the conditions of 1) the use of stent type device, 2) selection of the patients with MRI or CT, 3) shortening of the time to apply devices.
The Japanese guidelines for the management of stroke 2015 was published. It involved important evidences, searched from more than 23000 references for the stroke therapy. The classification of evidence levels were also improved.
