medicina60巻3号

2023年03月発行

特集 令和の脳卒中ディベート10番勝負—脳卒中治療ガイドライン2021とその先を識る

ディベート・セクション　10番勝負 急性再開通治療：脳主幹動脈閉塞例に対するdirect MT

Con　発症4.5時間以内で適応を満たせば，まずrt-PAを投与する

著者： 中島誠¹

所属機関： ¹熊本大学病院脳血管障害先端医療寄附講座

ページ範囲：P.463 - P.467

文献概要

　筆者は，脳主幹動脈閉塞例，特にrt-PA静注療法（iv-tPA）単独では再開通が得られにくいとされる内頸動脈閉塞例や脳底動脈閉塞例においても，発症4.5時間以内で適応を満たす症例には，機械的血栓回収療法（MT）単独治療ではなく，まずはiv-tPAを行うべきであるという立場で本論を進める．
　まず前提となる状況を想定する必要がある．1つには，この議論はiv-tPAとMTの両方が常時可能な施設への直接搬入例（mothership）を前提としている^1）．また閉塞血管としては，前方循環の主幹動脈，すなわち内頸動脈または中大脳動脈水平部を想定したうえで議論を進めたい．

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