大血管閉塞を伴う急性軽度虚血性脳卒中に対する機械的血栓摘出術の有効性と安全性

Efficacy and Safety of Mechanical Thrombectomy for Acute Mild Ischemic Stroke with Large Vessel Occlusion.

• Gui-Fang Wang
• Xue Zhao
• Shu-Ping Liu
• Yi-Lei Xiao
• Zu-Neng Lu

抄録

背景 大血管閉塞（LVO）による急性軽度虚血性脳卒中（AMIS）患者に対する機械的血栓摘出術（MT）の適合性については議論のあるところである。本研究では、AMISとLVOを有する患者における機械的血栓摘出術を評価した。材料および方法 大血管閉塞（LVO）を伴うAMISと診断された47人の患者にMTまたは静脈内血栓溶解療法（IVT）を行った。一次転帰はNational Institute of Health Stroke Scale（NIHSS）とmodified Rankin Scaleのスコアであった。副次的転帰は全身合併症の発生率と症候性頭蓋内出血であった。結果 性別、年齢、脳血管疾患の危険因子、既往歴、入院時のNIHSSスコア、血圧、LVO部位についてはIVT群とMT群で有意差はなかった。すべての患者において、退院時のNIHSSスコアは入院時よりも低かった。好転率はIVT群66.6％（16/24），MT群60.8％（14/23）であり，良好な転帰率はIVT群75％（18/24），MT群69.6％（16/23）であり，群間に有意差はなかった。全身性合併症はMT群12例（52.2％），IVT群5例（20.8％）であった。症候性頭蓋内出血はIVT群では認められなかったが，MT群では2例（8.7％）に認められた。90日間の追跡期間中にIVT群とMT群でそれぞれ1例が死亡し，死亡率はそれぞれ4.2％と4.4％であった。結論 LVOを有するAMIS患者において、MTとIVTの有効性は同等であった。MTは全身合併症の発生率が高かったが、短期および長期的な効果はIVTと同等であった。

BACKGROUND The suitability of mechanical thrombectomy (MT) for patients with acute mild ischemic stroke (AMIS) caused by large vessel occlusion (LVO) is controversial. This study evaluated MT in patients with AMIS and LVO. MATERIAL AND METHODS Forty-seven patients diagnosed as AMIS with LVO received MT or intravenous thrombolysis (IVT). Primary outcomes were National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale scores. Secondary outcomes were incidence of systemic complications and symptomatic intracranial hemorrhage. RESULTS There were no significant differences between IVT and MT groups for gender, age, risk factors of cerebrovascular disease, past history, NIHSS score at admission, blood pressure, and LVO sites. For all patients, the NIHSS scores at discharge were lower than those at admission. Patients with excellent outcomes were 66.6% (16/24) in the IVT group and 60.8% (14/23) in the MT group; favorable outcome rates were 75% (18/24) in the IVT group and 69.6% (16/23) in the MT group, with no significant differences between groups. Twelve patients (52.2%) in the MT group and 5 (20.8%) in the IVT group had systemic complications. Symptomatic intracranial hemorrhage was not detected in the IVT group, but manifested in 2 (8.7%) patients in the MT group. During 90-day follow-up, 1 patient died in each of the IVT and MT groups, with 4.2% and 4.4% mortality rates, respectively. CONCLUSIONS The efficacy of MT and IVT was comparable in AMIS patients with LVO. While MT had a higher incidence of systemic complications, its short- and long-term effects were equivalent to IVT.