守破離に学ぶ神経治療 ―Stroke Neurologistとして

抄録

Treatment for neurological disorders has made remarkable progress over the past two decades, a transformation that can be deeply understood through the traditional Japanese concept of “Shu–Ha–Ri”―a dynamic cycle of inheriting, breaking, and creating clinical paradigms. In the Shu (Tradition) phase, the establishment of the J–ACT trial defined a unique Japanese standard for low–dose alteplase (0.6 mg/kg), which became the foundational “form” of domestic stroke care, ensuring high safety and reproducibility through nationwide education. The Ha (Innovation) phase represents the breaking of existing frameworks through technological advancement, evidenced by the expansion of treatment windows via the ECASS III trial and the paradigm shift from “time–based” to “tissue–based” strategies. This era also witnessed the dramatic progress of mechanical thrombectomy and the optimization of regional emergency transport systems, such as the “Mothership” strategy. Currently, the field has entered the Ri (Creation) phase, pursuing optimal solutions beyond standard treatments tailored to patients' values. Key innovations include the introduction of tenecteplase as a next–generation thrombolytic, the emergence of “Stroke Oncology” guided by a three–axis evaluation model, and the creation of the “FAST–DAN” system for in–hospital strokes. Ultimately, this evolutionary cycle ensures that preserving tradition, embracing innovation, and creating new therapeutic systems fulfills the mission of stroke neurologist to pass on a lasting legacy to the next generation.