脳主幹動脈閉塞症に対するt-PA静注療法と急性期血行再建術の治療成績

抄録

Recently, endovascular therapy (EVT) for acute ischemic stroke has been developed to enhance early recanalization in patients who do not respond to intravenous recombinant tissue plasminogen activator (rt-PA). However, the efficacy of EVT remains uncertain. We compared clinical outcomes in patients treated with intravenous rt-PA alone (t-PA group; n=32) and those with EVT with/ without intravenous rt-PA (IVR group; n=42). The primary good outcome, defined as a modified Rankin Scale ≤2 at discharge, showed no statistical difference between the two groups (42.8% and 31.2%, chi-square: p = 0.31). In patients with internal carotid artery occlusion, the IVR group clearly showed better clinical outcomes than the t-PA group (Mann-Whitney U test: p = 0.019). Our clinical study indicates that in patients with internal carotid artery occlusion, EVT may be more effective as rescue therapy than intravenous rt-PA alone. Moreover, new generation devices, such as stent retrievers, are expected to have improved efficacy.