脳卒中治療薬

Therapeutic Strategies for Ischemic Stroke

脳卒中治療は，発症時（急性期）治療とその後の再発予防治療が重要である。脳梗塞急性期治療として，血栓溶解療法，局所血栓回収療法があり，再発予防は抗血栓療法を行う。脳梗塞の病型に応じて，アテローム血栓性脳梗塞，ラクナ梗塞に対しては，抗血小板療法が中心となり，また，心原性脳塞栓症に対しては，抗凝固療法が中心となる。そのほかに脳保護療法や，近年細胞再生治療なども行われるようになってきた。

Abstract

Ischemic stroke therapy consists of acute phase and preventive treatment strategies. Acute-phase ischemic stroke treatment includes systemic thrombolysis (rt-PA) and mechanical thrombectomy (endovascular therapy). Rt-PA is a very potent thrombolytic agent but its effectiveness is time-dependent. For the prevention of stroke recurrence (secondary stroke prevention) according to the TOAST classification, antiplatelet therapy (aspirin, clopidogrel, and cilostazol) is used for atherothrombotic and lacuna strokes, while anti-coagulant therapy (warfarin and direct oral anticoagulants [DOACs]) are used for cardiogenic cerebral embolism. Additionally, neuroprotective therapy using edaravone, a free radical scavenger, has recently been introduced to minimize brain tissue damage. Recently, neuronal regenerative therapies using stem cells have also been developed.