脳血管閉塞症の薬物治療—とくにdextran sulphateの血栓溶解療法への応用について（第1報）

TREATMENT OF CEREBROVASCULAR OCCLUSIVE DISEASE:SPECIAL REFERENCE TO ADMINISTR-ATION OF DEXTRAN SULPHATE AS FIBRINOLYTIC AGENT:A PRELIMINARY REPORT

はじめに

　近年，頭蓋内の脳血管閉塞に対しても，手術用顕微鏡を使用するmicroneurosurgeryの発達により，手術的治療の試みがなされるに至つた。中大脳動脈閉塞症に対するthrombectomy^1）2）3）や浅側頭動脈と中大脳動脈末梢血管との吻合^3）などによる血流再建などの報告が少なくない。しかし，発症早期に行なわれなければならないこの種の手術では，術後の脳浮腫を増強させること，また，かならずしも，術後の血管のpatencyが良くないなど，現在まだ，技術的な困難が少なくない。

　一方脳血管閉塞症に対する薬物療法もまた，近年多くの報告がなされているが，なかでも，血栓の溶解を目的^{4）5）6）7）8）9）10）}としたものは①fibrinolysinやthrombo—lysinなどのplasmin製剤，②streptokinaseやuro—kinaseなどの線溶活性物質，あるいは，③plasmin—activater mixtureなどが使用され，患側頸動脈への薬物の灌流^8）9）などの治療法も行なわれている。

Two cases of cerebrovascular occlusion that were treated by administration of dextran sulphate as fibrinolytic agent were reported.

One case was a 15 year-old boy wilh right internal carotid arterial occlusion at the intracranial siphon and received oral administration of 900 mg of dextran sulphate/day since 10 days after onset of left hemi-paresis attack. The symptom disappeard completely one month later.

The other was a 51 year-old woman wilh right middle cerebral arterial occlusion after selective right external carotid angiography because she had a parasaggital meningioma in the right parietal region. She received intravenous injection of 600 mg of dextran sulphate and 20, 000 unit of urokinase /day for 8 days untill the operation of the brain tumor. But, left flaccid hemiplegia dia not show any recovery. Angiography carried out after treatment demonstrated vascular clearing of occluded parts of cerebral arteries in both cases.

In this report, electrophoretic mobility of red cells of patients who received dextran sulphate therapy was also measured and these red cells showed more negative charge than those of controls. This may explain the anticoagulant and anti-sludging activity of dextran sulphate.

The fibrinolytic activity of dextran sulphate should be studied in more clinical cases in future.