シンポジウム14：神経救急における脳神経内科医の役割
脳卒中診療における脳神経内科医の活躍
2022 年 39 巻 4 号 p. 542-545
詳細
2022 年 39 巻 4 号 p. 542-545
Stroke is a common disease and is probably one of the most frequently encountered diseases by neurologists (especially neurologists working in general hospitals).
The approval of iv tPA in 2005 made stroke a “curable disease,” and the approval of the Merci Retrieval System in 2010 led to the current approval of highly effective stent retrievers and thrombus aspiration catheters for endovascular treatment. The Guidelines 2021 also recommend transvenous fibrinolysis and mechanical thrombectomy as “A” therapy, making acute stroke care a rapidly developing field.
Currently, about 70% of the members of the Stroke Association are neurosurgeons and 30% are neurologists, and it is estimated that less than half of neurologists treat strokes. In addition, only 7.8% of the specialists in the Japanese Society for Neuroendovascular Therapy are neurologists (as of August 2021). The new system is easier to use. In fact, 49 (12.1%) of the 404 certified physicians were neurologists, a higher percentage than that of the membership (9.7%). Although this is an area of growing interest among neurologists, treatment is currently not widespread in some areas, and further inroads into the field are desirable.
However, looking at stroke overall, most patients are not eligible for surgical treatment ; DPC data in 2019 shows that only 5.9% of stroke patients were treated with mechanical thrombectomy and 1.0% with direct surgery. Although attention tends to focus on flashy acute treatment, prevention of recurrence, lifestyle–related disease control, and rehabilitation based on disease type diagnosis are extremely important. A neurologist with broad knowledge and expertise in diagnosis and treatment would be an appropriate leader of a stroke team that manages patients while communicating with other departments, including neurosurgery, and multiple professions.
Acute treatments such as thrombolysis and mechanical thrombectomy are attractive to students and residents because of their dynamic and visible effects. The challenge for the future is to recruit personnel who should become leaders of the stroke team, using acute care as a gateway.
