循環器ジャーナル68巻4号

2020年10月発行

特集 抗血栓療法—日常臨床での疑問に応える Ⅳ．脳卒中に対する抗血栓療法

潜因性脳梗塞の抗血栓治療について

著者： 高橋潤一郎¹ 三村秀毅¹ 井口保之¹

所属機関： ¹東京慈恵会医科大学脳神経内科

ページ範囲：P.680 - P.686

Point
・昨今の検査機器，施設の充実，診断技術の進歩により，“十分な検査をしても原因の同定できない”潜因性脳梗塞の概念が生まれた．
・高解像度MRI DWI（3T-MRI）により，潜因性脳梗塞の多くは栓塞性機序を考慮する画像所見を示すことが判明している．
・ESUSを含めた潜因性脳梗塞の再発予防の抗血栓薬選択にNAVIGATE ESUS試験，RE-SPECT ESUS試験が行われたが，抗凝固薬の抗血小板薬への優位性は示せていない．
・近年，ESUSの塞栓源として50%未満の頸動脈プラークが注目されており，経食道心エコーを含めた積極的な検索で抗凝固薬の適応となる疾患がなければ抗血小板薬での治療を行い，適応があれば植込み型心電図記録計を導入し潜在性心房細動が見つかれば抗凝固薬に変更するなど，循環器内科医，脳神経内科医間の連携が必要である．

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