Neurological Surgery 脳神経外科42巻10号

2014年10月発行

連載 脳卒中専門医に必要な基本的知識

（3）脳梗塞急性期治療

著者： 山上宏¹

所属機関： ¹国立循環器病研究センター脳神経内科

ページ範囲：P.967 - P.983

Ⅰ．はじめに

　脳梗塞急性期の治療目的として，①閉塞血管の再灌流や脳保護薬を用いて虚血による神経細胞死を阻止すること，②抗血栓療法やリスク管理により虚血病変の拡大や早期の再発を防ぐこと，の2つが柱となる．これまでに多くの研究が行われてきたが，現時点で高いエビデンスが確立している治療法は，アルテプラーゼ静注療法とアスピリンによる抗血小板療法のみである．これは，脳神経細胞が虚血に対して極めて脆弱であること，脳梗塞の病態が多様であること，脳が出血性合併症を来しやすい組織であること，などが原因と考えられる．

　本稿では，これまでのエビデンスに基づく脳梗塞急性期治療の基本的知識を紹介するとともに，今後の展望についても述べる．

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