Neurological Surgery 脳神経外科51巻2号

2023年03月発行

特集 新時代を迎えた脳血管内治療—文献レビューで学ぶ進歩とトレンド Ⅲ 虚血性病変

脳塞栓〈医療体制編〉

著者： 山上宏¹

所属機関： ¹国立病院機構大阪医療センター脳卒中内科

ページ範囲：P.337 - P.346

Point
・脳主幹動脈閉塞例を効率的に脳卒中センターへ救急搬送する目的に，病院前脳卒中スケールが考案されている．
・直接搬送と転院搬送は，医療資源の密度や脳卒中センターへの距離など，地域の状況に合わせてシステムを構築する必要がある．
・院内診療体制として，転送例では直接血管造影室へ搬入して血栓回収療法を行うことの有用性が示されている．
・日本脳卒中学会により一次脳卒中センターの認定が進められ，脳卒中・循環器病対策基本法に基づいて医療体制の整備を行う必要がある．

参考文献

1）Rudd M, et al：A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J 33：818-822, 2016

2）Kimura K, et al：Kurashiki prehospital stroke scale. Cerebrovasc Dis 25：189-191, 2008

3）Pérez de la Ossa N, et al：Design and validation of a prehospital stroke scale to predict large arterial occlusion：the rapid arterial occlusion evaluation scale. Stroke 45：87-91, 2014

4）Singer OC, et al：A simple 3-item stroke scale：comparison with the National Institutes of Health Stroke Scale and prediction of middle cerebral artery occlusion. Stroke 36：773-776, 2005

5）Nazliel B, et al：A brief prehospital stroke severity scale identifies ischemic stroke patients harboring persisting large arterial occlusions. Stroke 39：2264-2267, 2008

6）Katz BS, et al：Design and validation of a prehospital scale to predict stroke severity：Cincinnati Prehospital Stroke Severity Scale. Stroke 46：1508-1512, 2015

7）Hastrup S, et al：Prehospital acute stroke severity scale to predict large artery occlusion：design and comparison with other scales. Stroke 47：1772-1776, 2016

8）Lima FO, et al：Field assessment stroke triage for emergency destination：a simple and accurate prehospital scale to detect large vessel occlusion strokes. Stroke 47：1997-2002, 2016

9）Suzuki K, et al：Emergent large vessel occlusion screen is an ideal prehospital scale to avoid missing endovascular therapy in acute stroke. Stroke 49：2096-2101, 2018

10）Uchida K, et al：Clinical prediction rules to classify types of stroke at prehospital stage. Stroke 49：1820-1827, 2018

11）Uchida K, et al；JUST Score Investigators：Simplified prehospital prediction rule to estimate the likelihood of 4 types of stroke：the 7-item Japan Urgent Stroke Triage（JUST-7）score. Prehosp Emerg Care 25：465-474, 2021

AD. Transl Stroke Res 11：664-670, 2020

13）Ismail M, et al：Mothership versus drip and ship for thrombectomy in patients who had an acute stroke：a systematic review and meta-analysis. J Neurointerv Surg 11：14-19, 2019

14）Pérez de la Ossa N, et al；RACECAT Trial Investigators：Effect of direct transportation to thrombectomy-capable center vs local stroke center on neurological outcomes in patients with suspected large-vessel occlusion stroke in nonurban areas：The RACECAT randomized clinical trial. JAMA 327：1782-1794, 2022

15）Turc G, et al：Comparison of mobile stroke unit with usual care for acute ischemic stroke management：a systematic review and meta-analysis. JAMA Neurol 79：281-290, 2022

16）Sarraj A, et al：Direct to angiography vs repeated imaging approaches in transferred patients undergoing endovascular thrombectomy. JAMA Neurol 78：916-926, 2021

17）Requena M, et al：Direct to angiography suite without stopping for computed tomography imaging for patients with acute stroke：a randomized clinical trial. JAMA Neurol 78：1099-1107, 2021

18）Nogueira RG, et al；DAWN Trial Investigators：Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378：11-21, 2018

19）Albers GW, et al；DEFUSE 3 Investigators：Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378：708-718, 2018

20）Albers GW, et al；AURORA Investigators：Assessment of optimal patient selection for endovascular thrombectomy beyond 6 hours after symptom onset：a pooled analysis of the AURORA database. JAMA Neurol 78：1064-1071, 2021

21）Nguyen TN, et al：Noncontrast computed tomography vs computed tomography perfusion or magnetic resonance imaging selection in late presentation of stroke with large-vessel occlusion. JAMA Neurol 79：22-31, 2022

22）厚生労働省：健康寿命の延伸等を図るための脳卒中，心臓病その他の循環器病に係る対策に関する基本法．2018　https://www.mhlw.go.jp/web/t_doc?dataId=80ab6708＆dataType=0＆pageNo=1

23）日本脳卒中学会，日本循環器学会：脳卒中と循環器病克服　第二次5カ年計画．ストップCVD（脳心血管病）健康長寿を達成するために．2021　https://www.jsts.gr.jp/img/20210820_5kanenn.pdf

24）日本脳卒中学会Telestrokeガイドライン作成プロジェクトチーム：脳卒中診療における遠隔医療（Telestroke）ガイドライン．脳卒中 42：443-463, 2020

25）Bivard A, et al：Artificial intelligence for decision support in acute stroke - current roles and potential. Nat Rev Neurol 16：575-585, 2020

26）Singer J, et al：Remote robotic endovascular thrombectomy for acute ischaemic stroke. BMJ Neurol Open 3：e000141, 2021　doi：10.1136/bmjno-2021-000141