アテローム血栓性脳主幹動脈閉塞症に対する急性期再開通療法の検討

Acute Thrombectomy for Atherothrombotic Major Vessel Occlusion

Ⅰ．はじめに

　脳主幹動脈閉塞症に対する急性期再開通療法の有効性が証明され^3,4,6,17)，近年はDEFUSE-3試験²⁾やDAWN試験¹⁵⁾などの結果から，その適応がさらに拡大されつつある．脳主幹動脈閉塞症の多くは心原性脳塞栓症であり，動脈硬化を背景としたアテローム血栓性機序の割合は低いが²¹⁾，両者を術前に鑑別することはしばしば困難である．当院で急性期再開通療法を施行した脳主幹動脈閉塞症を対象に，アテローム血栓性閉塞症における患者背景の特徴や治療成績について，後方視的に検討を行ったため報告する．

　Although the most common cause of major vessel occlusion is cardiogenic embolism（CE), atherothrombotic（AT）major vessel occlusion sometimes occur and recognize it during endovascular therapy. We evaluated the characteristics of patients with atherothrombotic major vessel occlusion who underwent endovascular therapy by comparing with them with those with cardiogenic embolism. We retrospectively evaluated 64 consecutive patients with major vessel occlusion who underwent endovascular thrombectomy between July 2014 and March 2018 in our institution. Eleven（17%）of the 64 patients were classified into the atherothombotic group based on the Trial of Org 10172 in Acute Stroke Treatment（TOAST）classification except for artery to artery embolism. In the AT group, the proportions of patients with younger age（67±13 years old vs. 77±11 years old, p＝0.048）and posterior circulation（55% vs. 8%, p＝0.001）were significantly higher than in the CE group. The mean times from onset to hospital arrival and from onset to revascularization were significantly longer in the AT group than in the CE group（313±325min vs. 129±67min, p＝0.008 and 468±359min vs. 280±93min, p＝0.018). No significant differences in the rate of successful revascularization and favorable outcome were found between the 2 groups. More patients in the AT group than in the CE group tended to maintain their previous modified Ranking Scale score（54% vs. 24%, p＝0.058). Our study shows that the patients with atherothrombotic major vessel occlusion had lower activities-of-daily living scores but attained high successful rates of revascularization and similar neurological outcome as that of multimodal endovascular therapy, as compared with the patients with cardiogenic embolism.