脳卒中治療Controversy

出版社： 中外医学社
著者：
発行日： 2023-03-20
分野： 臨床医学：内科  >  脳神経科学/神経内科学
ISBN： 9784498328969
電子書籍版： 2023-03-20 （1版1刷）
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商品紹介

抗凝固薬か抗血小板薬なのか？　血圧や糖尿病はどう管理するか？　スタチンは必要か？　CASをするのかCEAか？　減圧開頭するのかしないのか？　など常に判断の岐路に立たされる脳卒中治療の道しるべとなる必読書．緊急外来や病棟で直面する疑問を解消するための臨床にフォーカスした解説で明日からの診療がレベルアップ！

目次

  • 1　血栓回収療法前にrt—PA療法を行うべきか？
    2　ASPECTS 6未満の広範囲虚血の例に血栓回収療法は行うべきか？
    3　前大脳動脈閉塞や後大脳動脈閉塞に対して，血栓回収療法は行うべきか？
    4　発症24時間以降の症例に血栓回収療法を行ってよいか？
    5　血栓回収療法後，ヘパリンはリバースすべきか？
    6　血栓回収療法後の血圧のコントロールはどうすべきか？
    7　血栓回収療法前の血圧が高値の場合どうすべきか？
    8　DOACやワルファリン内服者の血栓回収療法はどうすべきか？
    9　rt—PA投与中の血栓回収療法でヘパリンは必要か？　不要か？　普段より減量すべきか？
    10　modified Rankin Scale（mRS）5以上の患者や高齢者の血栓回収療法はどうすべきか？
    11　脳梗塞軽症例にrt—PAを投与してもよいか？
    12　無症候性の脳出血が画像上にある場合，rt—PA療法はどうするか？
    13　無症候性の動脈瘤が画像上にある場合，rt—PA療法はどうするか？
    14　透析患者の虚血性脳血管障害に対してrt—PA療法を行ってよいか？
    15　MRI上，数日以内の無症候性の新鮮脳梗塞がある場合，rt—PA療法はどうするか？
    16　NIHSS 30以上の重症例にrt—PAを投与してよいか？
    17　rt—PA禁忌項目に該当する血圧高値を有する患者にどこまで積極的にrt—PAを使用するか？
    18　rt—PA投与後，24時間以内に症状が悪化した場合，抗血栓薬はいつから開始すべきか？
    19　(1)慢性硬膜下血腫のある患者にrt—PAは投与できるか？
    　　(2)慢性硬膜下血腫の既往のある患者にrt—PAは投与できるか？
    20　脳卒中急性期の高血糖はどうすべきか？
    21　発症48時間以内の脳梗塞急性期患者にシロスタゾールの投与は，妥当か？
    22　脳梗塞急性期にスタチンの投与は妥当か？
    23　脳梗塞急性期の治療に持続点滴は必要か？
    24　高張グリセロール静脈内投与はどのような患者に使うか？
    25　出血性梗塞に対する降圧は必要か？　残存閉塞血管の有無で降圧するかどうかを決めるべきか？
    26　ATBI患者における輸血療法の効果は期待できるか？
    　　（特に，一般的には輸血をしない範囲の，軽度貧血患者における輸血）
    27　非弁膜症性心房細動を伴う急性期脳梗塞患者にDOACはいつから使用すべきか？
    28　ヘパリンは脳梗塞急性期患者の治療に用いることは妥当か？
    29　脳動脈解離に対して抗血栓薬はどうすべきか？
    30　左心耳内血栓が認められた際に，抗凝固薬で様子を見るべきか，すぐに開胸術を行うべきか？
    31　症状増悪の脳梗塞患者へのアルガトロバン，デキストラン，補液等の追加の臨床改善効果は？
    　　　また，病型別で差はあるのか？
    32　出血性梗塞について，抗血栓薬はいつから開始すべきか？
    33　脳梗塞急性期，アスピリン内服中に脳梗塞を発症した場合，抗血栓薬をどうすべきか？
    34　急性期脳卒中のグリセオールとマンニットールはどのように使い分けるべきか？
    35　入院時，塞栓症が強く疑われる患者の抗血栓薬はどうするか？
    36　急性期の頭蓋内動脈の高度狭窄例に対して経動脈的な血管形成術や，ステント留置術は行うべきか？
    37　脳梗塞急性期に頸動脈内膜剝離術を行うのは妥当か？
    38　中大脳動脈灌流領域梗塞例で減圧開頭術を行う場合，いつ施行するか？〉
    39　急性期CASを行うのは妥当か？
    40　くも膜下出血患者の血圧管理はどうすべきか？
    41　高血圧性脳内出血超急性期におけるトラネキサム酸の止血効果に臨床的有用性はあるのか？
    42　急性期脳出血患者に，グリセロール製剤はどこまで効果があるのか？
    43　脳出血急性期患者の痙攣発作予防に抗てんかん薬を投与するか？
    44　高血圧性脳出血に対する降圧は，いつ，どれくらいまで，どのように行うべきか？
    45　抗血栓薬を内服中に発症した脳出血に対して，抗血栓薬の再開はどうすべきか？
    46　脳卒中の発症前から使用していた降圧薬は，発症直後から継続するか？
    47　脳出血の手術適応はどうすべきか　すぐか，1日待つか？
    48　皮質下出血の手術は妥当か？
    49　軽症脳卒中で頭蓋内血管に狭窄がない場合，座位をとらせてよいか？
    50　早期離床は脳卒中の病型ごとに考慮して行うべきか？
    51　頭蓋内圧亢進に対して頭部上半身の30°挙上は妥当か？
    52　脳卒中患者の超急性期からのリハビリテーションは有効か？
    53　失語に対するリハビリテーションは，いつから始めるか？
    54　嚥下障害に対するリハビリテーションは，いつ始めるか？
    55　脳卒中の予防として高トリグリセリド血症に対する薬物療法はどうするか？
    56　無症候の人に，頸動脈エコーで可動性プラークが発見された場合にどうするのがよいか？
    57　ワルファリン内服中に非弁膜症性心房細動患者で脳梗塞を発症した場合，抗凝固薬はどうすべきか？
    58　Microbleedsのあるラクナ梗塞に対して抗血栓薬は妥当か？
    59　Trousseau症候群の治療にDOACは妥当か？
    60　90歳以上の非弁膜症性心房細動の患者の抗凝固薬はどうするか？
    61　抗血小板薬を内服している患者が脳梗塞を起こした場合の抗血小板薬はどうするか？
    62　DOAC内服中に非弁膜症性心房細動患者で脳梗塞を発症した場合，抗凝固薬をどうすべきか？
    63　非弁膜症性心房細動患者で内頸動脈狭窄がある場合，抗血栓薬はどうすべきか？
    64　透析患者の非弁膜症性心房細動に対して脳梗塞の予防にワルファリンは使用すべきか？
    65　非弁膜症性心房細動がある重症脳梗塞患者で，意志疎通がとれない場合，
    　　　再発予防に抗凝固薬は投与すべきか？
    66　無症候性脳梗塞を有する患者に抗血栓薬はどうすべきか？
    67　無症候性内頸動脈狭窄を有する患者に抗血栓薬はどうすべきか？
    68　無症候性脳動脈瘤を有する患者に抗血栓薬はどうすべきか？
    69　大動脈原性脳梗塞の二次予防は，抗血小板薬と抗凝固薬のどちらがよいか？
    70　短い持続時間の心房細動の抗凝固療法はどうするか？
    71　ラクナ梗塞患者では，いつまで抗血栓療法を行うべきか．終了したほうがよいタイミングはあるか？
    72　心房細動を有する脳梗塞患者の再発予防にカテーテルアブレーションは有効か？
    73　脂質異常症がない頸動脈狭窄症（特に，いわゆる不安定プラークの所見があるもの）に対する
    　　　スタチンの投与は妥当か？
    74　狭窄度が軽度の症候性頸動脈狭窄患者に内膜剝離術は行うべきか？
    75　3 mmの未破裂脳動脈瘤はどうすべきか？
    76　脳卒中に認知症を合併した際，どう治療すべきか？
    77　脳卒中患者の胃瘻の適応はどうすべきか？
    78　左心耳内や左心房血栓の手術適応について，行った方がよいのか？
    79　卵円孔開存の関与が疑われる70歳の脳梗塞患者に経皮的卵円孔開存閉鎖術を行うのは妥当か？
    80　経皮的卵円孔開存閉鎖術を行った患者に対する抗血栓療法はどうすべきか？
    81　奇異性脳塞栓症の2次予防に抗血小板薬と抗凝固薬のどちらがよいか？
    82　30歳代のラクナ梗塞で，large PFOがみられた場合，経皮的卵円孔閉鎖術を行うべきか？

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

1 血栓回収療法前にrt - PA療法を行うべきか ?

P.3 掲載の参考文献
1) Kimura K, Iguchi Y, Shibazaki K, et al. Early recanalization rate of major occluded brain arteries after intravenous tissue plasminogen activator therapy using serial magnetic resonance angiography studies. Eur Neurol. 2009 ; 62 : 287-92.
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2) Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment : pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004 ; 363 : 768-74.
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3) Seners P, Turc G, Naggara O, et al. Post-thrombolysis recanalization in stroke referrals for thrombectomy : incidence, predictors, and prediction scores. Stroke. 2018 ; 49 : 2975-82.
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4) Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 ; 372 : 11-20.
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5) Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials. Lancet. 2016 ; 387 : 1723-31.
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2 ASPECTS 6 未満の広範囲虚血の例に血栓回収療法は行うべきか ?

P.8 掲載の参考文献
1) Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke : a meta-analysis of individual patient data from five randomised trials. Lancet. 2016 ; 387 : 1723-31.
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2) Roman LS, Menon BK, Blasco J, et al. Imaging features and safety and efficacy of endovascular stroke treatment : a meta-analysis of individual patient-level data. Lancet Neurol. 2018 ; 17 : 895-904.
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3) Kakita H, Yoshimura S, Uchida K, et al. Impact of endovascular therapy in patients with large ischemic core : subanalysis of recovery by endovascular salvage for cerebral ultra-acute embolism Japan Registry 2. Stroke. 2019 ; 50 : 901-8.
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4) Yoshimura S, Sakai N, Yamagami H, et al. Endovascular therapy for acute stroke with a large ischemic region. N Engl J Med. 2022.
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3 前大脳動脈閉塞や後大脳動脈閉塞に対して, 血栓回収療法は行うべきか ?

P.12 掲載の参考文献
1) Ospel JM, Goyal M. A review of endovascular treatment for medium vessel occlusion stroke. J NeuroIntervent Surg. 2021 ; 13 : 623-30.
 
2) 日本脳卒中学会脳卒中ガイドライン委員会, 編. 脳卒中治療ガイドライン 2021. 東京 : 協和企画 ; 2021. p.60.
 
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5) Enomoto M, Shigeta K, Ota T, et al. Predictors of intracranial hemorrhage in acute ischemic stroke after endovascular thrombectomy. Interv Neuroradiol. 2020 ; 26 : 368-75.
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6) Kurre W, Vorlaender K, Aguilar-Perez M, et al. Frequency and relevance of anterior cerebral artery embolism caused by mechanical thrombectomy of middle cerebral artery occlusion. AJNR Am J Neuroradiol. 2013 ; 34 : 1606-11.
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7) Meyer L, Stracke CP, Jungi N, et al. Thrombectomy for primary distal posterior cerebral artery occlusion stroke : The TOPMOST Study. JAMA Neurol. 2021 ; 78 : 434-44.
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8) Park H, Jeong YS, Lee SH, et al. Clinical prognosis of isolated anterior cerebral artery territory infarction : a retrospective study. BMC Neurol. 2021 ; 21 : 171.
 
9) Herweh C, Abdalkader C, Nguyen TN, et al. Mechanical thrombectomy in isolated occlusion of the proximal posterior cerebral artery. Front Neurol. 2021 ; 12 : 697348.
 
10) Monteiro A, Khan S Waqas M, et al. Mechanical thrombectomy versus intravenous alteplase alone in acute isolated posterior cerebral artery occlusion : a systematic review. J Neurointerv Surg. 2021 Nov 2 ; Online ahead of print.
 
11) Goyal M, Cimflova P, Ospel JM, et al. Endovascular treatment of anterior cerebral artery occlusions. J Neurointerv Surg. 2021 ; 13 : 1007-11.
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12) Menon BK, Hill MD, Davalos A, et al. Efficacy of endovascular thrombectomy in patients with M2 segment middle cerebral artery occlusions : meta-analysis of data from the HERMES Collaboration. J Neurointerv Surg. 2019 ; 11 : 1065-9.
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4 発症24時間以降の症例に血栓回収療法を行ってよいか ?

P.18 掲載の参考文献
1) Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018 ; 378 : 11-21.
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3) Jovin TG, Nogueira RG, Lansberg MG, et al. Thrombectomy for anterior circulation stroke beyond 6 h from time last known well (AURORA) : a systematic review and individual patient data meta-analysis. Lancet. 2022 ; 399 : 249-58.
 
4) Terasawa Y, Kimura K, Iguchi Y, et al. Could clinical-diffusion mismatch determined using DWI ASPECTS predict neurological improvement after thrombolysis before 3 h after stroke? J Neurol Neurosurg Psychiatry. 2010 ; 81 : 864-8.
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7) Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015 ; 372 : 1019-30.
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10) Pirson FAVA, Hinsenveld WH, Goldhoorn RB, et al. MR CLEAN-LATE, a multicenter randomized clinical trial of endovascular treatment of acute ischemic stroke in The Netherlands for late arrivals : study protocol for a randomized controlled trial. Trials. 2021 ; 22 : 160.
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12) Liu X, Dai Q, Ye R, et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST) : an open-label, randomised controlled trial. Lancet Neurol. 2020 ; 19 : 115-22.
 
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15) Desai SM, Haussen DC, Aghaebrahim A, et al. Thrombectomy 24 hours after stroke : beyond DAWN. J Neurointerv Surg. 2018 ; 10 : 1039-42.
 
16) Casetta I, Fainardi E, Pracucci G, et al. Endovascular treatment beyond 24 hours from the onset of acute ischemic stroke : the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS). J Neurointerv Surg. 2021 Nov 3 ; neurintsurg-2021-018045. doi : 10.1136/neurintsurg-2021-018045.
 
17) Kim BJ, Menon BK, Kim JY, et al. Endovascular treatment after stroke due to large vessel occlusion for patients presenting very late from time last known well. JAMA Neurol. 2021 ; 78 : 21-9.
 
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5 血栓回収療法後, ヘパリンはリバースすべきか ?

P.23 掲載の参考文献
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4) Dalkara T, Arsava EM. Can restoring incomplete microcirculatory reperfusion improve stroke outcome after thrombolysis? J Cereb Blood Flow Metab. 2012 ; 32 : 2091-9.
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5) Rocha EA, Ji R, Ay h, et. al. Reduced ischemic lesion growth with heparin in acute ischemic stroke. J Stroke Cerebrovasc Dis. 2019 ; 28 : 1500-8.
 
6) Puntonet J, Richard ME, Edjlali M, et al. Imaging findings after mechanical thrombectomy in acute ischemic stroke clinical implications and perspectives. Stroke. 2019 ; 50 : 1618-25.
 
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6 血栓回収療法後の血圧のコントロールはどうすべきか ?

P.28 掲載の参考文献
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7 血栓回収療法前の血圧が高値の場合どうすべきか ?

P.33 掲載の参考文献
1) Zhao R, Liu FD, Wang S, et al. Blood pressure reduction in the acute phase of an ischemic stroke does not improve short or long term dependency or mortality : a meta-analysis of current literature. Medicine (Baltimore). 2015 ; 94 : e896.
 
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8 DOACやワルファリン内服者の血栓回収療法はどうすべきか ?

P.37 掲載の参考文献
1) Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 ; 372 : 11-20.
PubMed
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PubMed
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PubMed
4) Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015 ; 372 : 2285-95.
PubMed
5) Jovin TG, Cobo DE, deMiquel MA, et al. Thrombectomy within 8 Hours after symptom onset in ischemic stroke. N Engl J Med. 2015 ; 372 : 2296-306.
 
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PubMed
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PubMed
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9 rt - PA投与中の血栓回収療法でヘパリンは必要か ? 不要か ? 普段より減量すべきか ?

P.43 掲載の参考文献
1) van de Graaf RA, Chalos V, van Es ACGM, et al. Periprocedural intravenous heparin during endovascular treatment for ischemic stroke : Results from the MR CLEAN Registry. Stroke. 2019 ; 50 : 2147-55.
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PubMed
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PubMed
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PubMed
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PubMed
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PubMed
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10 modified Rankin Scale ( mRS ) 5 以上の患者や高齢者の血栓回収療法はどうすべきか ?

P.48 掲載の参考文献
1) Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015 ; 372 : 11-20.
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2) 内閣府. 高齢化の現状と将来像. In : 高齢社会白書. 令和3年版. 東京 : 日経印刷 ; 2021. p.2-6.
 
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PubMed
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11 脳梗塞軽症例にrt - PAを投与してもよいか ?

P.53 掲載の参考文献
1) 豊田一則, 井口保之, 岡田靖, 他. 静注血栓溶解 (rt-PA) 療法適正治療指針 第三版. 脳卒中. 2019 ; 41 : 205-46.
 
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12 無症候性の脳出血が画像上にある場合, rt - PA療法はどうするか ?

P.57 掲載の参考文献
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9) Cordonnier C, Al-Shahi Salman R, Wardlaw J, et al. Spontaneous brain microbleeds : systematic review, subgroup analyses and standards for study design and reporting. Brain. 2007 ; 130 : 1988-2003.
PubMed
10) Kim SH, Shin DW, Yun JM, et al. Kidney dysfunction and cerebral microbleeds in neurologically healthy adults. PLoS One. 2017 ; 12 : e0172210.
PubMed
11) Yates PA, Desmond PM, Phal PM, et al. Incidence of cerebral microbleeds in preclinical Alzheimer disease. Neurology. 2014 ; 82 : 1266-73.
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12) Wang Z, Soo YO, Mok VC, et al. Cerebral microbleeds : is antithrombotic therapy safe to administer? Stroke. 2014 ; 45 : 2811-7.
PubMed
13) Pantoni L. Cerebral small vessel disease : From pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010 ; 9 : 689-701.
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14) Charidimou A, Kakar P, Fox Z, et al. Cerebral microbleeds and recurrent stroke risk : systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts. Stroke. 2013 ; 44 : 995-1001.
PubMed
15) Bokura H, Saika R, Yamaguchi T, et al. Microbleeds are associated with subsequent hemorrhagic and ischemic stroke in healthy elderly individuals. Stroke. 2011 ; 42 : 1867-71.
PubMed
16) Altmann-Schneider I, Trompet S, de Craen AJ, et al. Cerebral microbleeds are predictive of mortality in the elderly. Stroke. 2011 ; 42 : 638-44.
PubMed
17) The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 ; 333 : 1581-7.
 
18) Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 ; 359 : 1317-29.
PubMed
19) 日本脳卒中学会 脳卒中医療向上・社会保険委員会 静注血栓溶解療法指針改訂部会. 静注血栓溶解 (rt-PA) 療法 適正治療指針 第三版, 2019.
Medical*Online
20) Yamaguchi T, Mori E, Minematsu K, et al. Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset : Japan Alteplase Clinical Trial. Stroke. 2006 ; 37 : 1810-5.
 
21) Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke : an updated pooled analysis 1 of ECASS, ATLANTIS NINDS, and EPITHET trials. Lancet. 2010 ; 375 : 1695-703.
PubMed
22) Boisseau W, Fahed R, Lapergue B, et al. Predictors of parenchymal hematoma after mechanical thrombectomy : a multicenter study. Stroke. 2019 ; 50 : 2364-70.
PubMed
23) Paciaroni M, Agnelli G, Corea F, et al. Early hemorrhagic transformation of brain infarction : rate, predictive factors, and influence on clinical outcome : results of a prospective multicenter study. Stroke. 2008 ; 39 : 2249-56. 10.1161/STROKEAHA.107.510321
 
24) Aoki J, Shibazaki K, Saji N, et al. Risk of intracerebral hemorrhage after thrombolysis in patients with asymptomatic hemorrhage on T2*. Cerebrovasc Dis. 2014 ; 38 : 107-16.
PubMed
25) Charidimou A, Kakar P, Fox Z, et al. Cerebral microbleeds and the risk of intracerebral haemorrhage after thrombolysis for acute ischaemic stroke : systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2013 ; 84 : 277-80.
PubMed
26) Charidimou A, Turc G, Oppenheim C, et al. Microbleeds, cerebral hemorrhage, and functional outcome after stroke thrombolysis. Stroke. 2017 ; 48 : 2084-90.
PubMed
27) Tsivgoulis G, Zand R, Katsanos AH, et al. Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden : a meta-analysis. JAMA Neurol. 2016 ; 73 : 675-83.
 

13 無症候性の動脈瘤が画像上にある場合, rt - PA療法はどうするか ?

P.62 掲載の参考文献
1) 日本脳卒中学会医療向上・社会保険委員会rt-PA (アルテプラーゼ) 静注療法指針部会. rt-PA (アルテプラーゼ) 静注療法適正治療指針 2005年10月. 脳卒中. 2005 ; 27 : 327-54.
 
2) 峰松一夫, 中川原譲二, 森悦朗, 他. 日本脳卒中学会脳卒中医療向上・社会保険委員会rt-PA (アルテプラーゼ) 静注療法指針改訂部会. rt-PA (アルテプラーゼ) 静注療法適正治療指針 (第二版). 脳卒中. 2012 ; 34 : 443-80.
 
3) 豊田一則, 井口保之, 岡田靖, 他. 日本脳卒中学会脳卒中医療向上・社会保険委員会静注血栓溶解療法指針改訂部会. 静注血栓溶解 (rt-PA) 療法 適正治療指針 第三版. 脳卒中. 2019 ; 41 : 205-46.
 
4) Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke : 2019 update to the 2018 guidelines for the early management of acute ischemic stroke : A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 ; 50 : e344-418.
 
5) 端和夫. 未破裂脳動脈瘤を虚血性脳血管障害急性期のrt-PA静注療法の禁忌とすることは妥当か. 脳卒中. 2008 ; 30 : 72-6.
 
6) Edwards NJ, Kamel H, Josephson A. The safety of intravenous thrombolysis for ischemic stroke in patients with pre-existing cerebral aneurysms : a case series and review of the literature. Stroke. 2012 ; 43 : 412-6.
 
7) Goyal N, Tsivgoulis G, Zand R, et al. Systemic thrombolysis in acute ischemic stroke patients with unruptured intracranial aneurysms. Neurology. 2015 ; 85 : 1452-8.
PubMed
8) Mowla A, Singh K, Mehla S, et al. Is acute reperfusion therapy safe in acute ischemic stroke patients who harbor unruptured intracranial aneurysm? Int J Stroke. 2015 ; 10 Suppl A100 : 113-8.
 
9) Rammos SK, Neils DM, Fraser K, et al. Anterior communicating artery aneurysm rupture after intravenous thrombolysis for acute middle cerebral artery thromboembolism : case report. Neurosurgery. 2012 ; 70 : E1603-7.
PubMed
10) Benes V 3rd, Jurak L, Jedlicka J, et al. Fatal intracranial aneurysm rupture after thrombolytic treatment for ischemic stroke : a case report and literature review. Acta Neurochir (Wien). 2019 ; 161 : 1337-41.
PubMed
11) Haji F, van Adel B, Avery M, et al. Intracranial aneurysm rupture following intravenous thrombolysis for stroke. Can J Neurol Sci. 2014 ; 41 : 95-8.
PubMed
12) UCAS Japan Investigators, Morita A, Kirino T, Hashi K, et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012 ; 366 : 2474-82.
 
13) Tominari S, Morita A, Ishibashi T, et al. Prediction model for 3-year rupture risk of unruptured cerebral aneurysms in Japanese patients. Ann Neurol. 2015 ; 77 : 1050-9.
PubMed
14) Podlasek A, Dhillon PS, Butt W, et al. Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke : a meta-analysis of randomized controlled trials. Int J Stroke. 2021 ; 16 : 621-31.
PubMed

14 透析患者の虚血性脳血管障害に対してrt - PA療法を行ってよいか ?

P.66 掲載の参考文献
1) de Jager DJ, Grootendorst DC, Jager KJ, et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA. 2009 ; 302 : 1782-9.
PubMed
2) 統計調査委員会一般社団法人 日本透析医学会. 2019年末の慢性透析患者に関する集計, 第2章 2019年慢性透析患者の動態. 2019. p.583-7.
 
3) Sozio SM, Armstrong PA, Coresh J, et al. Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis : the choices for healthy outcomes in caring for ESRD (CHOICE) study. Am J Kidney Dis. 2009 ; 54 : 468-77.
PubMed
4) Toyoda K, Fujii K, Fujimi S, et al. Stroke in patients on maintenance hemodialysis : A 22-year single-center study. Am J Kidney Dis. 2005 ; 45 : 1058-66.
PubMed
5) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 ; 333 : 1581-7.
PubMed
6) Bluhmki E, Chamorro A, Davalos A, et al. Stroke treatment with alteplase given 3.0-4.5h after onset of acute ischaemic stroke (ECASS III) : additional outcomes and subgroup analysis of a randomised controlled trial. Lancet Neurol. 2009 ; 8 : 1095-102.
 
7) Naganuma M, Koga M, Shiokawa Y, et al. Reduced estimated glomerular filtration rate is associated with stroke outcome after intravenous rt-PA : the Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement (SAMURAI) rt-PA registry. Cerebrovasc Dis. 2011 ; 31 : 123-9.
PubMed
8) Lyrer PA, Fluri F, Gisler D, et al. Renal function and outcome among stroke patients treated with IV thrombolysis. Neurology. 2008 ; 71 : 1548-50.
PubMed
9) Agrawal V, Rai B, Fellows J, et al. In-hospital outcomes with thrombolytic therapy in patients with renal dysfunction presenting with acute ischaemic stroke. Nephrol Dial Transplant. 2010 ; 25 : 1150-7.
PubMed
10) 日本脳卒中学会 脳卒中医療向上・社会保険委員会 静注血栓溶解療法指針改訂部会. 静注血栓溶解 (rt-PA) 療法 適正治療指針 第三版. 2019.
Medical*Online
11) Naganuma M, Mori M, Nezu T, et al. Intravenous recombinant tissue plasminogen activator therapy for stroke patients receiving maintenance hemodialysis : the Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement (SAMURAI) rt-PA registry. Eur Neurol. 2011 ; 66 : 37-41.
PubMed
12) Palacio S, Gonzales NR, Sangha NS, et al. Thrombolysis for acute stroke in hemodialysis : international survey of expert opinion. Clin J Am Soc Nephrol. 2011 ; 6 : 1089-93.
PubMed
13) Tariq N, Adil MM, Saeed F, et al. Outcomes of thrombolytic treatment for acute ischemic stroke in dialysis-dependent patients in the United States. J Stroke Cerebrovasc Dis. 2013 ; 22 : e354-9.
PubMed
14) Govan L, Langhorne P, Weir CJ. Does the prevention of complications explain the survival benefit of organized inpatient (stroke unit) care? : further analysis of a systematic review. Stroke. 2007 ; 38 : 2536-40.
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18) 脳卒中ガイドライン委員会日本脳卒中学会, 脳卒中ガイドライン 2021. 2021.
 
19) Brunet P, Simon N, Opris A, et al. Pharmacodynamics of unfractionated heparin during and after a hemodialysis session. Am J Kidney Dis. 2008 ; 51 : 789-95.
 
20) Meretoja A, Putaala J, Tatlisumak T, et al. Off-label thrombolysis is not associated with poor outcome in patients with stroke. Stroke. 2010 ; 41 : 1450-8.
 

15 MRI上, 数日以内の無症候性の新鮮脳梗塞がある場合, rt - PA療法はどうするか ?

P.70 掲載の参考文献
1) Strbian D, Sairanen T, Meretoja A, et al. Patient outcomes from symptomatic intracerebral hemorrhage after stroke thrombolysis. Neurology. 2011 ; 77 : 341-8.
PubMed
2) Yaghi S, Willey JZ, Cucchiara B, et al. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke : A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017 ; 48 : e343-61.
PubMed
3) Tisserand M, Le Guennec L, Touze E, et al. Prevalence of MRI-defined recent silent ischemia and associated bleeding risk with thrombolysis. Neurology. 2011 ; 76 : 1288-95.
PubMed
4) Thomalla G, Schwark C, Sobesky J, et al. Outcome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients : comparison of a German multicenter study with the pooled data of ATLANTIS, ECASS, and NINDS tPA trials. Stroke. 2006 ; 37 : 852-8.
 
5) Trouillas P, von Kummer R. Classification and pathogenesis of cerebral hemorrhages after thrombolysis in ischemic stroke. Stroke. 2006 ; 37 : 556-61.
PubMed
6) Gaillard N, Schmidt C, Costalat V, et al. Hemorrhagic risk of recent silent cerebral infarct on prethrombolysis MR imaging in acute stroke. AJNR Am J Neuroradiol. 2012 ; 33 : 227-31.
PubMed
7) Cho AH, Kim JS, Kim SJ, et al. Focal fluid-attenuated inversion recovery hyperintensity within acute diffusion-weighted imaging lesions is associated with symptomatic intracerebral hemorrhage after thrombolysis. Stroke. 2008 ; 39 : 3424-6.
PubMed
8) Petkova M, Rodrigo S, Lamy C, et al. MR imaging helps predict time from symptom onset in patients with acute stroke : implications for patients with unknown onset time. Radiology. 2010 ; 257 : 782-92.
PubMed

16 NIHSS 30以上の重症例にrt - PAを投与してよいか ?

P.74 掲載の参考文献
1) Brott T, Adams HP, Olinger CP, et al. Measurements of acute cerebral infarction : a clinical examination scale. Stroke. 1989 ; 20 : 864-70.
PubMed
2) Whiteley WN, Emberson J, Lees KR, et al. Risk of intracerebral haemorrhage with alteplase after acute ischaemic stroke : a secondary analysis of an individual patient data meta-analysis. Lancet Neurol. 2016 ; 15 : 925-33.
PubMed
3) Yamaguchi T, Mori E, Minematsu K, et al. Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset : Japan Alteplase Clinical Trial (J-ACT). Stroke. 2006 ; 37 : 1810-5.
 
4) Toyoda K, Koga M, Naganuma M, et al. Routine use of intravenous low-dose recombinant tissue plasminogen activator in Japanese patients : general outcomes and prognostic factors from the SAMURAI register. Stroke. 2009 ; 40 : 3591-5.
PubMed
5) Seners P, Turc G, Maier B, et al. Incidence and predictors of early recanalization after intravenous thrombolysis : a systematic review and meta-analysis. Stroke. 2016 ; 47 : 2409-12.
PubMed
6) Yang P, Zhang Y, Zhang L, et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med. 2020 ; 382 : 1981-93.
PubMed
7) Suzuki K, Matsumaru Y, Takeuchi M, et al. Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke : The SKIP Randomized Clinical Trial. JAMA. 2021 ; 325 : 244-53.
PubMed
8) LeCouffe NE, Kappelhof M, Treurniet KM, et al. A randomized trial of intravenous alteplase before endovascular treatment for stroke. N Engl J Med. 2021 ; 385 : 1833-44.
PubMed
9) Zi W, Qiu Z, Li F, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke : The DEVT Randomized Clinical Trial. JAMA. 2021 ; 325 : 234-43.
PubMed
10) Schonewille WJ, Wijman CAC, Michel P, et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS) : a prospective registry study. Lancet Neurol. 2009 ; 8 : 724-30.
PubMed
11) Strbian D, Sairanen T, Silvennoinen H, et al. Intravenous thrombolysis of basilar artery occlusion : thrombus length versus recanalization success. Stroke. 2014 ; 45 : 1733-8.
PubMed
12) Lindsberg PJ, Soinne L, Tatlisumak T, et al. Long-term outcome after intravenous thrombolysis of basilar artery occlusion. JAMA. 2004 ; 292 : 1862-6.
PubMed
13) Singer OC, Berkefeld J, Nolte CH, et al. Mechanical recanalization in basilar artery occlusion : the ENDOSTROKE study. Ann Neurol. 2015 ; 77 : 415-24.
PubMed
14) Gory B, Eldesouky I, Sivan-Hoffmann R, et al. Outcomes of stent retriever thrombectomy in basilar artery occlusion : an observational study and systematic review. J Neurol Neurosurg Psychiatry. 2016 ; 87 : 520-5.
PubMed
15) Kang D-H, Jung C, Yoon W, et al. Endovascular thrombectomy for acute basilar artery occlusion : a multicenter retrospective observational study. J Am Heart Assoc. 20187 ; 7 : e009419.
 
16) Liu X, Dai Q, Ye R, et al. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST) : an open-label, randomised controlled trial. Lancet Neurol. 2020 ; 19 : 115-22.
 
17) Langezaal LCM, van der Hoeven EJRJ, Mont' Alverne FJA, et al. Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med. 2021 ; 384 : 1910-20.
PubMed
18) Kaneko J, Ota T, Tagami T, et al. Endovascular treatment of acute basilar artery occlusion : Tama-REgistry of Acute Thrombectomy (TREAT) study. J Neurol Sci. 2019 ; 401 : 29-33.
PubMed
19) Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke : 2019 update to the 2018 guidelines for the early management of acute ischemic stroke : A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 ; 50 : e344-418.
 

17 rt - PA禁忌項目に該当する血圧高値を有する患者にどこまで積極的にrt - PAを使用するか ?

P.79 掲載の参考文献
1) Omer FD, Habib C, Cenap O, et al. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 ; 333 : 1581-7.
 
2) Yamaguchi T, Mori E, Minematsu K, et al. Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset Japan Alteplase Clinical Trial (J-ACT). Stroke. 2006 ; 37 : 1810-5.
 
3) 日本脳卒中学会 脳卒中医療向上・社会保険委員会. 静注血栓溶解療法指針改訂部会. 静注血栓溶解 (rt-PA) 療法 適正使用指針 第三版, 2019.
 
4) Intercollegiate Stroke Working Party. National clinical guideline for stroke, 5th ed. London : Royal College of Physicians ; 2016.
 
5) Wahlgren N, Ahmed N, Eriksson N, et al. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomised controlled trials : safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST). Stroke. 2008 ; 39 : 3316-22.
PubMed
6) Ahmed N, Wahlgren N, Brainin M, et al. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis : retrospective analysis from safe implementation of thrombolysis in stroke-international stroke thrombolysis registry (SITS-ISTR). Stroke. 2009 ; 40 : 2442-9.
 
7) Brott T, Lu M, Kothari R, et al. Hypertension and its treatment in the NINDS rt-PA stroke trial. Stroke. 1998 ; 29 : 1504-9.
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8) Craig SA, Yining H, Richard IL, et al. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED) : an international, randomised, open-label, blinded-endpoint, phase 3 trial. Lancet. 2019 ; 393 : 877-88.
 

18 rt - PA投与後, 24時間以内に症状が悪化した場合, 抗血栓薬はいつから開始すべきか ?

P.83 掲載の参考文献
1) 日本脳卒中学会 脳卒中医療向上・社会保険委員会. 静注血栓溶解療法指針改訂部会. 豊田一則. 静注血栓溶解 (rt-PA) 療法適正治療指針 第三版. 脳卒中. 2019 ; 41 : 205-38.
 
2) Astrup J, Symon L, Branston NM, et al. Cortical evoked potential and extracellular K+ and H+ at critical levels of brain ischemia. Stroke. 1977 ; 8 : 51-7.
 
3) Inohara T, Liang L, Xian Y, et al. Thrombolytic therapy in older acute ischemic stroke patients with gastrointestinal malignancy or recent bleeding. Eur Stroke J. 2020 ; 1 : 47-55.
 
4) Mishra A, Rao A, Pimpalwar Y. Ultrasound guided percutaneous injection of thrombin : Effective technique for treatment of iatrogenic femoral pseudoaneurysms. J Clin Diagn Res. 2017 ; 11 : TC04-TC06.
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5) Zinkstok SM, Roos YB, on behalf of the ARTIS investigators. Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke : a randomized controlled trial. Lancet. 2012 ; 380 : 731-37.
 
6) Yamaguchi T, Mori E, Shinohara Y, et al. Japan Alteplase Clinical Trial (J-ACT) Group. Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset : Japan Alteplase Clinical Trial (J-ACT). Stroke. 2006 ; 37 : 1810-5.
 
7) Xian Y, Federspiel JJ, Grau-Sepulveda M, et al. Risks and benefits associated with prestroke antiplatelet therapy among patients with acute Ischemic stroke treated with intravenous tissue plasminogen activator. JAMA Neurol. 2016 ; 73 : 50-9.
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8) Meseguer E, Labreuche J, Guidoux C, et al. Outcomes after stroke thrombolysis according to prior antiplatelet use. Int J Stroke. 2015 ; 10 : 163-9.
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9) Lindley RI, Wardlaw JM, Whiteley WN, et al. IST-3 Collaborative Group. Alteplase for acute ischemic stroke : outcomes by clinically important subgroups in the Third International Stroke Trial. Stroke. 2015 ; 46 : 746-56.
 
10) Pan X, Zhu Y, Zheng D, et al. Prior antiplatelet agent use and outcomes after intravenous thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke : a meta-analysis of cohort studies and randomized controlled trials. Int J Stroke. 2015 ; 10 : 317-23.
PubMed
11) Diedler J, Ahmed N, Sykora M, et al. Safety of intravenous thrombolysis for acute ischemic stroke in patients receiving antiplatelet therapy at stroke onset. Stroke. 2010 ; 41 : 288-94.
PubMed
12) Bluhmki E, Chamorro A, Davalos A, et al. Stroke treatment with alteplase given 3.0-4.5 h after onset of acute ischaemic stroke (ECASS III) : additional outcomes and subgroup analysis of a randomised controlled trial. Lancel Neurol. 2009 ; 8 : 1095-102.
 
13) Schmulling S, Rudolf J, Strotmann-Tack T, et al. Acetylsalicylic acid pretreatment, concomitant heparin therapy and the risk of early intracranial hemorrhage following systemic thrombolysis for acute ischemic stroke. Cerebrovasc Dis. 2003 ; 16 : 183-90.
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14) Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 ; 359 : 1317-29.
PubMed
15) Chen CJ, Ding D, Worrall BB, et al. Endovascular vs medical management of acute ischemic stroke. Neurology. 2015 ; 85 : 1980-90.
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19 ( 1 ) 慢性硬膜下血腫のある患者にrt - PAは投与できるか ? ( 2 ) 慢性硬膜下血腫の既往のある患者にrt - PAは投与できるか ?

P.88 掲載の参考文献
1) 日本脳卒中学会 脳卒中医療向上・社会保険委員会, 静注血栓溶解療法指針改訂部会. 静注血栓溶解 (rt-PA) 療法適正治療指針 第三版. 2019年3月. <https://www.jsts.gr.jp/img/rt-PA03.pdf>
 
2) 日本脳卒中学会 医療向上・社会保険委員会, rt-PA (アルテプラーゼ) 静注療法指針部会rt-PA (アルテプラーゼ) 静注療法適正治療指針. 2005年10月. 脳卒中, 2005 ; 27 : 327-54.
 
3) Caton Jr MT, Wiggins WF, Nunez D. Non-traumatic subdural hemorrhage : Beware of ruptured intracranial aneurysm. Emerg Radiol. 2019 ; 26 : 567-71.
 
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6) Katano H, Kamiya K, Mase M, et al. Tissue plasminogen activator in chronic subdural hematomas as a predictor of recurrence. Neurosurg. 2006 ; 104 : 79-84.
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7) 佐藤祥一郎, 高田達郎, 豊田一則, 他. CTではなくMRIで硬膜下血腫を診断しアルテプラーゼ静注療法を断念した1例. 脳卒中. 2006 ; 28 : 408-10.
 
8) 永井秀政, 高田大慶, 宮嵜健史, 他. 慢性硬膜下血腫術後に発生した脳底動脈血栓塞栓症でのtPA静注療法の使用経験. 脳卒中. 2008 ; 30 : 266.
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Medical*Online

20 脳卒中急性期の高血糖はどうすべきか ?

P.92 掲載の参考文献
1) Bruno A, Biller J, Adams Jr HP, et al. Acute blood glucose level and outcome from ischemic stroke. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Neurology. 1999 ; 52 : 280-4.
 
2) Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients : A systematic overview. Stroke. 2001 ; 32 : 2426-32.
PubMed
3) Scott JF, Robinson GM, French JM, et al. Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet. 1999 ; 353 : 376-7.
PubMed
4) Weir CJ, Murray GD, Dyker AG, et al. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. BMJ. 1997 ; 314 : 1303-6.
PubMed
5) Parsons MW, Barber PA, Desmond PM, et al. Acute hyperglycemia adversely affects stroke outcome : A magnetic resonance imaging and spectroscopy study. Ann Neurol. 2002 ; 52 : 20-8.
PubMed
6) Baird TA, Parsons MW, Phan T, et al. Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke. 2003 ; 34 : 2208-14.
PubMed
7) Prado R, Ginsberg MD, Dietrich WD, et al. Hyperglycemia increases infarct size in collaterally perfused but not end-arterial vascular territories. J Cereb Blood Flow Metab. 1988 ; 8 : 186-92.
 
8) de Courten-Myers GM, Kleinholz M, Wagner KR, et al. Normoglycemia (not hypoglycemia) optimizes outcome from middle cerebral artery occlusion. J Cereb Blood Flow Metab. 1994 ; 14 : 227-36.
 
9) Anderson RE, Tan WK, Martin HS, et al. Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke. 1999 ; 30 : 160-70.
PubMed
10) Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 ; 44 : 870-947.
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11) American Diabetes Association. Standards of medical care in diabetes-2010. Diabetes Care. 2010 ; 33 (suppl 1) : S11-61.
 
12) 日本脳卒中学会脳卒中ガイドライン委員会, 編. 2 脳卒中急性期 2-1 全身管理 (5) 栄養など. 脳卒中治療ガイドライン 2021. 東京 : 協和企画 ; 2021. p.32-3.
 
13) Demchuk AM, Morgenstern LB, Krieger DW, et al. Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. Stroke. 1999 ; 30 : 34-9.
PubMed
14) Bruno A, Levine SR, Frankel MR, et al. Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology. 2002 ; 59 : 669-74.
PubMed
15) Ribo M, Molina C, Montaner J, et al. Acute hyperglycemia state is associated with lower tPA-induced recanalization rates in stroke patients. Stroke. 2005 ; 36 : 1705-9.
PubMed
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17) Toyoda K, Koga M, Naganuma M, et al. Routine use of intravenous low-dose recombinant tissue plasminogen activator in Japanese patients : general outcomes and prognostic factors from the SAMURAI register. Stroke. 2009 ; 40 : 3591-5.
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18) Gray CS, Hildreth AJ, Sandercock PA, et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia : The UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurol. 2007 ; 6 : 397-406.
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PubMed

21 発症48時間以内の脳梗塞急性期患者にシロスタゾールの投与は, 妥当か ?

P.97 掲載の参考文献
1) Yasunaga K, Mase K. Clinical effects of oral cilostazol on suppression of platelet function in patients with cerebrovascular disease. Arzneimittelforschung. 1985 ; 35 : 1186-8.
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2) Shinohara Y, Katayama Y, Uchiyama S, et al. CSPS 2 group. Cilostazol for prevention of secondary stroke (CSPS
 
2) : an aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol. 2010 ; 9 : 959-68.
PubMed
3) Toyoda K, Uchiyama S, Yamaguchi T, et al. CSPS.com Trial Investigators. Dual antiplatelet therapy using cilostazol for secondary prevention in patients with high-risk ischaemic stroke in Japan : A multicentre, open-label, randomised controlled trial. Lancet Neurol. 2019 ; 18 : 539-48.
PubMed
4) International Stroke Trial Collaborative Group. The International Stroke Trial (IST) : A randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet. 1997 ; 349 : 1569-81.
PubMed
5) Chen ZM, Sandercock P, Pan HC, et al. Indications for early aspirin use in acute ischemic stroke : A combined analysis of 40 000 randomized patients from the chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups. Stroke. 2000 ; 31 : 1240-9.
 
6) Wang Y, Wang Y, Zhao X, et al ; CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013 ; 369 : 11-9.
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7) Johnston SC, Easton JD, Farrant M, et al. Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018 ; 379 : 215-25.
 
8) Bath PM, Woodhouse LJ, Appleton JP, et al ; TARDIS Investigators. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS) : a randomised, open-label, phase 3 superiority trial. Lancet. 2018 ; 391 : 850-9.
 
9) 日本脳卒中学会 脳卒中治療ガイドライン 委員会, 編. 脳卒中治療ガイドライン 2021. II 脳梗塞・TIA 1 脳梗塞急性期 1-3 抗血小板療法. 東京 : 協和企画 ; 2021.
 
10) Lee YS, Bae HJ, Kang DW, et al. Cilostazol in acute ischemic stroke treatment (CAIST Trial) : A randomized double-blind non-inferiority trial. Cerebrovasc Dis. 2011 ; 32 : 65-71.
 
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PubMed

22 脳梗塞急性期にスタチンの投与は妥当か ?

P.102 掲載の参考文献
1) Squizzato A, Romualdi E, Dentali F, et al. Statins for acute ischemic stroke. Cochrane Database Syst Rev. 2011 : Cd007551.
PubMed
2) Heo JH, Song D, Nam HS, et al. Effect and safety of rosuvastatin in acute ischemic stroke. J Stroke. 2016 ; 18 : 87-95.
PubMed
3) Briel M, Schwartz GG, Thompson PL, et al. Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes : A meta-analysis of randomized controlled trials. JAMA. 2006 ; 295 : 2046-56.
PubMed
4) Hong KS, Lee JS. Statins in acute ischemic stroke : A systematic review. J Stroke. 2015 ; 17 : 282-301.
PubMed
5) Blanco M, Nombela F, Castellanos M, et al. Statin treatment withdrawal in ischemic stroke : A controlled randomized study. Neurology. 2007 ; 69 : 904-10.
PubMed
6) Guo Y, Guo X, Zhao K, et al. Statin use and outcomes of patients with acute ischemic stroke treated with intravenous thrombolysis : A systematic review and meta-analysis. Front Neurol. 2021 ; 12 : 734927.
 
7) Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of ldl cholesterol : A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 ; 376 : 1670-81.
PubMed

23 脳梗塞急性期の治療に持続点滴は必要か ?

P.107 掲載の参考文献
1) Rahman H, Khan SU, Nasir F, et al. Optimal duration of aspirin plus clopidogrel after ischemic stroke or transient ischemic attack. Stroke. 2019 ; 50 : 947-53.
 
2) Wada T, Yasunaga H, Horiguchi H, et al. Outcomes of argatroban treatment in patients with atherothrombotic stroke : Observational nationwide study in Japan. Stroke. 2016 ; 47 : 471-6.
PubMed
3) Hou X, Jin C, Pan C, et al. Effects of argatroban therapy for stroke patients : A meta-analysis. J Clin Neurosci. 2021 ; 90 : 225-32.
PubMed
4) Wang X, Ouyang M, Yang J, et al. Anticoagulants for acute ischaemic stroke. Cochrane Database Syst Rev. 2021 ; 10 : CD000024.
PubMed
5) Badve MS, Zhou Z, van de Beek D, et al. Frequency of post-stroke pneumonia : Systematic review and meta-analysis of observational studies. Int J Stroke. 2019 ; 14 : 125-36.
PubMed
6) Qureshi AI, Palesch YY, Barsan WG, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016 ; 375 : 1033-43.
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7) 日本脳卒中学会 脳卒中医療向上・社会保険委員会 静注血栓溶解療法指針改定部会. 静注血栓溶解 (rt-PA) 療法 適正治療指針 第三版. 脳卒中. 2019 ; 41 : 206-46.
 
8) Dirnagl U, Klehmet J, Braun JS, et al. Stroke-induced immunodepression : experimental evidence and clinical relevance. Stroke. 2007 ; 38 : 770-3.
PubMed

24 高張グリセロール静脈内投与はどのような患者に使うか ?

P.110 掲載の参考文献
1) Dietis A, Ehteshami S, Harrison MJ, et al. The effect of isovolaemic haemodilution and intravenous glycerol on the sequelae of middle cerebral artery occlusion in the rat. J Neurol Neurosurg Psychiatry. 1986 ; 49 : 428-30.
 
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3) Meyer JS, Itoh Y, Okamoto S, et al. Circulatory and metabolic effects of glycerol infusion in patients with recent cerebral infarction. Circulation. 1975 ; 51 : 701-12.
PubMed
4) Bayer AJ, Pathy MS, Newcombe R. Double-blind randomised trial of intravenous glycerol in acute stroke. Lancet. 1987 ; 1 (8530) : 405-8.
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6) Righetti E, Celani MG, Cantisani T, et al. Glycerol for acute stroke. Cochrane Database Syst Rev. 2004 ; (2) : CD000096.
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7) 日本脳卒中学会脳卒中ガイドライン委員会, 編. 脳卒中治療ガイドライン 2021. 東京 : 協和企画 ; 2021.
 
8) Kimura K, Minematsu K, Yamaguchi T, Japan Multicenter Stroke Investigators C. Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry. 2005 ; 76 : 679-83.
 

25 出血性梗塞に対する降圧は必要か ? 残存閉塞血管の有無で降圧するかどうかを決めるべきか ?

P.114 掲載の参考文献
1) Von Kummer R, Broderick JP, Campbell BCV, et al. The Heidelberg bleeding classification : Classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke. 2015 ; 46 : 2981-6.
PubMed
2) Malhotra K, Goyal N, Katsanos AH, et al. Association of blood pressure with outcomes in acute stroke thrombectomy. Hypertension. 2020 ; 75 : 730-9.
PubMed
3) John S, Hazaa W, Uchino K, et al. Timeline of blood pressure changes after intra-arterial therapy for acute ischemic stroke based on recanalization status. J Neurointerv Surg. 2017 ; 9 : 455-8.
PubMed
4) Carvalho Dias M, Gabriel D, Saraiva M, et al. Spontaneous systolic blood pressure drop early after mechanical thrombectomy predicts dramatic neurological recovery in ischaemic stroke patients. Eur Stroke J. 2020 ; 5 : 362-9.
PubMed
5) 日本脳卒中学会脳卒中ガイドライン委員会, 編. 2. 脳卒中急性期, 2-1 全身管理. 日本脳卒中学会脳卒中治療ガイドライン 2021. 東京 : 協和企画 ; p.27-28.
 
6) Powers WJ, Rabinstein AA, Ackerson T, et al : American Heart Association Stroke Council. Guidelines for the early management of patients with acute ischemic stroke : 2019 update to the 2018 guidelines for the early management of acute ischemic stroke. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019 ; 50 : e344-418.
 
7) Sandset EC, Anderson CS, Bath PM, et al. European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage. Eur Stroke J. 2021 ; 6 : X48-L89.
 
8) Turc G, Bhogal P, Fischer U, et al. European stroke organisation (ESO) -European society for minimally invasive neurological therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischaemic Stroke Endorsed by stroke alliance for Europe (SAFE). Eur Stroke J. 2019 ; 4 : 6-12.
 
9) Talke PO, Sharma D, Heyer EJ, et al. Society for neuroscience in anesthesiology and critical care expert consensus statement : anesthetic management of endovascular treatment for acute ischemic stroke. Stroke. 2014 ; 45 : e138-50.
 
10) Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018 ; 378 : 11-21.
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11) Mazighi M, Richard S, Lapergue B ; et al. BP-TARGET investigators. Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET) : A multicentre, open-label, randomised controlled trial. Lancet Neurol. 2021 ; 20 : 265-74.
 
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13) Petersen NH, Silverman A, Strander SM, et al. Fixed compared with autoregulation-oriented blood pressure thresholds after mechanical thrombectomy for ischemic stroke. Stroke. 2020 ; 51 : 914-21.
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14) Sheriff F, Castro P, Kozberg M, et al. Dynamic cerebral autoregulation post endovascular thrombectomy in acute ischemic stroke. Brain Sci. 2020 ; 10 : 641.
PubMed

26 ATBI患者における輸血療法の効果は期待できるか ? ( 特に, 一般的には輸血をしない範囲の, 軽度貧血患者における輸血 )

P.118 掲載の参考文献
1) Kellert L, Schrader F, Ringleb P, et al. The impact of low hemoglobin levels and transfusion on critical care patients with severe ischemic stroke : STroke : RelevAnt Impact of HemoGlobin, Hematocrit and Transfusion (STRAIGHT) --an observational study. J Crit Care. 2014 ; 29 : 236-40.
PubMed
2) Moman RN, Kor DJ, Chandran A, et al. Red blood cell transfusion in acute brain injury subtypes : An observational cohort study. J Crit Care. 2019 ; 50 : 44-9.
PubMed
3) Kim C, Lee SH, Lim JS, et al. Timing of transfusion, not hemoglobin variability, is associated with 3-month outcomes in acute ischemic stroke. J Clin Med. 2020 ; 9 : 1566.
 
4) Rubinstein C, Davenport DL, Dunnagan R, et al. Intraoperative blood transfusion of one or two units of packed red blood cells is associated with a fivefold risk of stroke in patients undergoing elective carotid endarterectomy. J Vasc Surg. 2013 ; 57 : 53S-7S.
PubMed
5) Bucerius J, Gummert JF, Borger MA. et al. Stroke after cardiac surgery : a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003 ; 75 : 472-8.
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6) Wang Y, Shi X, Du R, et al. Impact of red blood cell transfusion on acute coronary syndrome : a meta-analysis. Intern Emerg Med. 2018 ; 13 : 231-41.
 
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8) Zallen G, Moore EE, Ciesla DJ, et al. Stored red blood cells selectively activate human neutrophils to release IL-8 and secretory PLA2. Shock. 2000 ; 13 : 29-33.
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9) Silvain J, Pena A, Cayla G, et al. Impact of red blood cell transfusion on platelet activation and aggregation in healthy volunteers : results of the TRANSFUSION study. Eur Heart J. 2010 ; 31 : 2816-21.
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10) Tanne D, Molshatzki N, Merzeliak O, et al. Anemia status, hemoglobin concentration and outcome after acute stroke : a cohort study. BMC Neurol. 2010 ; 10 : 22.
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14) Chang TS, Jensen MB. Haemodilution for acute ischaemic stroke. Cochrane Database Syst Rev. 2014 ; 2014 : CD000103.
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18) Dexter F, Hindman BJ. Effect of haemoglobin concentration on brain oxygenation in focal stroke : a mathematical modelling study. Br J Anaesth. 1997 ; 79 : 346-51.
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20) Tsai CF, Yip PK, Chen CC, et al. Cerebral infarction in acute anemia. J Neurol. 2010 ; 257 : 2044-51.
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21) 米村雄士, 松本雅則, 稲田英一, 他. 科学的根拠に基づいた赤血球製剤の使用ガイドライン (改訂). 日本輸血細胞治療学会誌. 2018 ; 64 : 688-99.
Medical*Online

27 非弁膜症性心房細動を伴う急性期脳梗塞患者にDOACはいつから使用すべきか ?

P.122 掲載の参考文献
1) 日本脳卒中学会 脳卒中治療ガイドライン委員会. 脳卒中治療ガイドライン 2021. 東京 : 協和企画 ; 2021.
 
2) Steffel J, Collins R, Antz M, et al. 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. EP Europace. 2021 ; 23 : 1612-76.
 
3) Toyoda K, Arihiro S, Todo K, et al. Trends in oral anticoagulant choice for acute stroke patients with nonvalvular atrial fibrillation in Japan : the SAMURAI-NVAF study. Int J Stroke. 2015 ; 10 : 836-42.
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4) Mizoguchi T, Tanaka K, Toyoda K, et al. Early initiation of direct oral anticoagulants after onset of stroke and short- and long-term outcomes of patients with nonvalvular atrial fibrillation. Stroke. 2020 ; 51 : 883-91.
 
5) Seiffge DJ, Paciaroni M, Wilson D, et al. Direct oral anticoagulants versus vitamin K antagonists after recent ischemic stroke in patients with atrial fibrillation. Ann Neurol. 2019 ; 85 : 823-34.
PubMed
6) Yasaka M, Minematsu K, Toyoda K, et al. Rivaroxaban administration after acute ischemic stroke : The RELAXED study. PLoS One. 2019 ; 14 : e0212354.
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7) Labovitz AJ, Rose DZ, Fradley MG, et al. Early apixaban use following stroke in patients with atrial fibrillation : results of the AREST Trial. Stroke. 2021 ; 52 : 1164-71.
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8) Kimura S, Toyoda K, Yoshimura S, et al. The practical "1-2-3-4-day" rule for starting direct oral anticoagulants after ischemic stroke with atrial fibrillation : combined hospital-based cohort study. Stroke. 2022 ; 53 : 1540-9.
PubMed

28 ヘパリンは脳梗塞急性期患者の治療に用いることは妥当か ?

P.126 掲載の参考文献
1) International stroke trial collaborative group. The international stroke trial (IST). A randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet. 1997 ; 349 : 1569-81.
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2) Saxena R, Lewis S, Berge E, et al. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the international stroke trial. Stroke. 2001 ; 32 : 2333-7.
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3) Camerlingo M, Salvi P, Belloni G, et al. Intravenous heparin started within the first 3 hours after onset of symptoms as a treatment for acute nonlacunar hemispheric cerebral infarctions. Stroke. 2005 ; 36 : 2415-20.
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4) The publications committee for the trial of org 10172 in acute stroke treatment (TOAST) investigators. Low molecular weight heparinoid, org 10172 (danaparoid), and outcome after acute ischemic stroke : A randomized controlled trial. JAMA. 1998 ; 279 : 1265-72.
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5) Berge E, Abdelnoor M, Nakstad PH, et al. Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation : A double-blind randomised study. HAEST study group. Heparin in acute embolic stroke trial. Lancet. 2000 ; 355 : 1205-10.
 
6) Bath PM, Lindenstrom E, Boysen G, et al. Tinzaparin in acute ischaemic stroke (TAIST) : A randomised aspirin-controlled trial. Lancet. 2001 ; 358 : 702-10.
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7) Wong KS, Chen C, Ng PW, et al. Low-molecular-weight heparin compared with aspirin for the treatment of acute ischaemic stroke in asian patients with large artery occlusive disease : A randomised study. Lancet Neurol. 2007 ; 6 : 407-13.
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8) Yi X, Lin J, Wang C, et al. Low-molecular-weight heparin is more effective than aspirin in preventing early neurologic deterioration and improving six-month outcome. J Stroke Cerebrovasc Dis. 2014 ; 23 : 1537-44.
 
9) Whiteley WN, Adams HP, Jr, Bath PM, et al. Targeted use of heparin, heparinoids, or low-molecular-weight heparin to improve outcome after acute ischaemic stroke : An individual patient data meta-analysis of randomised controlled trials. Lancet Neurol. 2013 ; 12 : 539-45.
PubMed
10) Paciaroni M, Agnelli G, Micheli S, et al. Efficacy and safety of anticoagulant treatment in acute cardioembolic stroke : A meta-analysis of randomized controlled trials. Stroke. 2007 ; 38 : 423-30.
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11) Sandercock PA, Counsell C, Kane EJ. Anticoagulants for acute ischaemic stroke. Cochrane Database Syst Rev. 2015 ; 2015 : Cd000024.
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29 脳動脈解離に対して抗血栓薬はどうすべきか ?

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30 左心耳内血栓が認められた際に, 抗凝固薬で様子を見るべきか, すぐに開胸術を行うべきか ?

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31 症状増悪の脳梗塞患者へのアルガトロバン, デキストラン, 補液等の追加の臨床改善効果は ? また, 病型別で差はあるのか ?

P.141 掲載の参考文献
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32 出血性梗塞について, 抗血栓薬はいつから開始すべきか ?

P.147 掲載の参考文献
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33 脳梗塞急性期, アスピリン内服中に脳梗塞を発症した場合, 抗血栓薬をどうすべきか ?

P.152 掲載の参考文献
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34 急性期脳卒中のグリセオールとマンニットールはどのように使い分けるべきか ?

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35 入院時, 塞栓症が強く疑われる患者の抗血栓薬はどうするか ?

P.160 掲載の参考文献
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36 急性期の頭蓋内動脈の高度狭窄例に対して経動脈的な血管形成術や, ステント留置術は行うべきか ?

P.166 掲載の参考文献
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37 脳梗塞急性期に頸動脈内膜.離術を行うのは妥当か ?

P.170 掲載の参考文献
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38 中大脳動脈灌流領域梗塞例で減圧開頭術を行う場合, いつ施行するか ?

P.175 掲載の参考文献
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39 急性期CASを行うのは妥当か ?

P.181 掲載の参考文献
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40 くも膜下出血患者の血圧管理はどうすべきか ?

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41 高血圧性脳内出血超急性期におけるトラネキサム酸の止血効果に臨床的有用性はあるのか ?

P.189 掲載の参考文献
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42 急性期脳出血患者に, グリセロール製剤はどこまで効果があるのか ?

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43 脳出血急性期患者の痙攣発作予防に抗てんかん薬を投与するか ?

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44 高血圧性脳出血に対する降圧は, いつ, どれくらいまで, どのように行うべきか ?

P.200 掲載の参考文献
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45 抗血栓薬を内服中に発症した脳出血に対して, 抗血栓薬の再開はどうすべきか ?

P.205 掲載の参考文献
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3) Song L, Sandset EC, Arima H, et al : INTERACT2 Investigators. Early blood pressure lowering in patients with intracerebral haemorrhage and prior use of antithrombotic agents : pooled analysis of the INTERACT studies. J Neurol Neurosurg Psychiatry. 2016 ; 87 : 1330-5.
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46 脳卒中の発症前から使用していた降圧薬は, 発症直後から継続するか ?

P.210 掲載の参考文献
1) 日本脳卒中学会 脳卒中ガイドライン委員会, 編. 脳卒中治療ガイドライン 2021. 東京 ; 協和企画 ; 2021.
 
2) Robinson TG, Potter JF, Ford GA, et al. Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS) : a prospective, randomised, open, blinded-endpoint trial. Lancet Neurol. 2010 ; 9 : 767-75.
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PubMed

47 脳出血の手術適応はどうすべきか すぐか, 1日待つか ?

P.215 掲載の参考文献
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48 皮質下出血の手術は妥当か ?

P.221 掲載の参考文献
1) van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin : a systematic review and meta-analysis. Lancet Neurol. 2010 ; 9 : 167-76.
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PubMed
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49 軽症脳卒中で頭蓋内血管に狭窄がない場合, 座位をとらせてよいか ?

P.225 掲載の参考文献
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50 早期離床は脳卒中の病型ごとに考慮して行うべきか ?

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51 頭蓋内圧亢進に対して頭部上半身の30°挙上は妥当か ?

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52 脳卒中患者の超急性期からのリハビリテーションは有効か ?

P.238 掲載の参考文献
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53 失語に対するリハビリテーションは, いつから始めるか ?

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54 嚥下障害に対するリハビリテーションは, いつ始めるか ?

P.250 掲載の参考文献
1) Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke : 2019 update to the 2018 guidelines for the early management of acute ischemic stroke : a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019 ; 50 : e344-418.
 
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55 脳卒中の予防として高トリグリセリド血症に対する薬物療法はどうするか ?

P.254 掲載の参考文献
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56 無症候の人に, 頸動脈エコーで可動性プラークが発見された場合にどうするのがよいか ?

P.259 掲載の参考文献
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57 ワルファリン内服中に非弁膜症性心房細動患者で脳梗塞を発症した場合, 抗凝固薬はどうすべきか ?

P.262 掲載の参考文献
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58 Microbleedsのあるラクナ梗塞に対して抗血栓薬は妥当か ?

P.267 掲載の参考文献
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59 Trousseau症候群の治療にDOACは妥当か ?

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60 90歳以上の非弁膜症性心房細動の患者の抗凝固薬はどうするか ?

P.280 掲載の参考文献
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61 抗血小板薬を内服している患者が脳梗塞を起こした場合の抗血小板薬はどうするか ?

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62 DOAC内服中に非弁膜症性心房細動患者で脳梗塞を発症した場合, 抗凝固薬をどうすべきか ?

P.293 掲載の参考文献
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63 非弁膜症性心房細動患者で内頸動脈狭窄がある場合, 抗血栓薬はどうすべきか ?

P.297 掲載の参考文献
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64 透析患者の非弁膜症性心房細動に対して脳梗塞の予防にワルファリンは使用すべきか ?

P.302 掲載の参考文献
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65 非弁膜症性心房細動がある重症脳梗塞患者で, 意志疎通がとれない場合, 再発予防に抗凝固薬は投与すべきか ?

P.306 掲載の参考文献
1) 日本脳卒中学会 脳卒中ガイドライン委員会. 脳卒中治療ガイドライン 2021. 2021. p.66-8, 96-8.
 
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66 無症候性脳梗塞を有する患者に抗血栓薬はどうすべきか ?

P.310 掲載の参考文献
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67 無症候性内頸動脈狭窄を有する患者に抗血栓薬はどうすべきか ?

P.315 掲載の参考文献
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68 無症候性脳動脈瘤を有する患者に抗血栓薬はどうすべきか ?

P.319 掲載の参考文献
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69 大動脈原性脳梗塞の二次予防は, 抗血小板薬と抗凝固薬のどちらがよいか ?

P.323 掲載の参考文献
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70 短い持続時間の心房細動の抗凝固療法はどうするか ?

P.327 掲載の参考文献
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71 ラクナ梗塞患者では, いつまで抗血栓療法を行うべきか. 終了したほうがよいタイミングはあるか ?

P.330 掲載の参考文献
1) 日本脳卒中学会 脳卒中ガイドライン委員会. 脳卒中治療ガイドライン 2015. 2015.
 
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72 心房細動を有する脳梗塞患者の再発予防にカテーテルアブレーションは有効か ?

P.335 掲載の参考文献
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73 脂質異常症がない頸動脈狭窄症 ( 特に, いわゆる不安定プラークの所見があるもの ) に対するスタチンの投与は妥当か ?

P.338 掲載の参考文献
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74 狭窄度が軽度の症候性頸動脈狭窄患者に内膜剥離術は行うべきか ?

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75 3mmの未破裂脳動脈瘤はどうすべきか ?

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76 脳卒中に認知症を合併した際, どう治療すべきか ?

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77 脳卒中患者の胃瘻の適応はどうすべきか ?

P.357 掲載の参考文献
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78 左心耳内や左心房血栓の手術適応について, 行った方がよいのか ?

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79 卵円孔開存の関与が疑われる70歳の脳梗塞患者に経皮的卵円孔開存閉鎖術を行うのは妥当か ?

P.368 掲載の参考文献
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80 経皮的卵円孔開存閉鎖術を行った患者に対する抗血栓療法はどうすべきか ?

P.373 掲載の参考文献
1) 日本脳卒中学会, 日本循環器学会, 日本心血管インターベンション治療学会 潜因性脳梗塞に対する経皮的卵円孔開存閉鎖術の手引き. 2019. p.1-24.
 
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PubMed
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81 奇異性脳塞栓症の2次予防に抗血小板薬と抗凝固薬のどちらがよいか ?

P.378 掲載の参考文献
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82 30歳代のラクナ梗塞で, large PFOがみられた場合, 経皮的卵円孔閉鎖術を行うべきか ?

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