急性期脳梗塞に対する血管内再開通療法の進歩

Progression of Endovascular Treatment for Acute Ischemic Stroke

Ⅰ．はじめに

　急性期脳梗塞に対する血管内再開通療法は脳血管内治療の黎明期から行われ，本邦においても20年以上の歴史がある^8,9)．初期にはウロキナーゼの局所動注療法やバルーン血管拡張術が行われてきたが，2010年に機械型血栓回収デバイスのMerci^® Retrieval System（Stryker, Michigan, USA）が導入され，2011年には吸引型のPenumbra System^®（Penumbra, California, USA），2014年にはステント型デバイスのSolitaire^TM FR Device（Medtronic, Minnesota, USA）が導入された．デバイスの改良に伴って，成績も向上している印象がある．

　しかし，その間に電子カルテが紙カルテに取って代わり，また，医師は転勤が多く，施設の救急医療に対する取り組みが異なるなどの理由で，以前の成績と現在のそれとを比較するのは困難な状況にある．そこで，筆頭著者が勤務し記録した手術記録と患者ファイル，施設保存の患者情報を基に，初期の3年間の治療と最近の3年間のものとを比較して，急性期脳梗塞に対する再開通療法の変遷と治療成績を検討した．

　OBJECTIVE:Percutaneous transluminal recanalization（PTR）has been performed for more than 20 years and progressing because of the development of endovascular devices. However, the results have been changing dramatically since PTR was first introduced owing to dynamic social environments. Thus, we evaluated the progression of the treatment by reviewing the medical records of patients who received the treatment.

　MATERIALS and METHODS:The present author has worked in three hospitals and performed PTR for 39 cases of acute ischemic stroke from 1996 to 1998. From 2012 to 2014, PTR was performed for 57 cases, and results were compared between the early and recent periods by using patient medical files and records.

　RESULTS:Elderly patients were treated with PTR in the recent period. The main target of PTR was the M1 segment of the middle cerebral artery in the early period. The internal carotid artery-to-posterior circulation ratio increased in the recent period. Regarding the methods of PTR, mechanical retrieval devices were mainly used in the recent period and resulted in a significantly more complete recanalization. The recovery rate based on the Glasgow outcome scale score increased, and the mortality rate decreased significantly in the recent period.

　CONSLUSIONS:Along with the development of endovascular devices, the results of PTR have been improving.