脳梗塞急性期の再開通療法と脳神経内科医の役割

抄録

Recanalization therapy for acute stroke has become widespread as a treatment with a high level of evidence and continue to develop. We discuss trends in recanalization therapy after the publication of Japanese Stroke Treatment Guideline 2021, the time management, and the role of neurologists.

It is still unclear whether the combination of intravenous thrombolysis (IVT) can be skipped in mechanical thrombectomy (MT) for large vessel occlusion (LVO), although several randomized controlled trials (RCTs) have been reported. The AURORA Database, an analysis of six RCTs that investigated the effects of MT in late presenting stroke, reported two important results : MT was effective in both perfusion mismatch and clinical mismatch profile, and MT was effective in any period between 6 and 24 hours. The RESCUE–Japan LIMIT Clinical Trial in Japan reported a significant increase in the modify Rankin Scale 0–3 at 90 days with MT, the first RCT to report the benefit of MT in LVO with large core infarction. Recently, two RCTs have demonstrated the efficacy of MT for basilar artery occlusion within 12 hours (ATTENTION) and within 6–24 hours (BAOCHE). It is important to confirm the criteria for the trials in which efficacy was demonstrated. There is still no evidence of MT for medium vessel occlusion including M2.

The pre–hospital phase is crucial in shortening the in–hospital time. It is important to be fully prepared prior to patient arrival. Our role is to organize the team as a leader by applying our management skills developed through our IVT treatment.

Neurologists can contribute our knowledge and skills to endovascular treatment, even if we do not perform endovascular treatment ourselves.