脳塞栓〈医療体制編〉

Cerebral Embolism:System of Care

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．

　The efficacy and safety of endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion have been established, and a shorter time from onset to reperfusion has a strong impact on the outcome. Therefore, improving the stroke system of care, including ambulance transportation, is important. Trials on efficient transport have been conducted using the pre-hospital stroke scale, comparison of mothership and drip and ship systems, and workflow after arrival to stroke centers. The Japan Stroke Society has started to certify primary stroke centers and core primary stroke centers（thrombectomy-capable stroke centers）. We review the literature on stroke systems of care and discuss policies that academic societies and policies are aiming for in Japan.