トランジント・イシュケミア・アタックと急性・イシュケミア・ストロックの診断と管理: レビュー

Scott J Mendelson¹, Shyam Prabhakaran^1,2

¹Department of Neurology, University of Chicago, Chicago, Illinois.

JAMA

|March 16, 2021

まとめ

高リスクのトランジタ・イシェミック・アタック (TIA) と軽度の脳卒中に対する早期の二重抗血小板治療はリスクを下げます. 急性不全性脳卒中 (AIS) の無効化には,適時な血栓解剖と機械的血栓切除が機能的アウトカムを大幅に改善します.

科学分野:

神経学
心血管医学
公衆衛生

背景:

脳卒中はアメリカでは死と障害の主な原因で毎年約800,000人が罹患しています
急性不全性脳卒中 (AIS) と一時性不全性脳卒中 (TIA) は,短期的な脳卒中のリスクが異なる異なる脳血管疾患です.
高リスクの患者を特定し適切な介入を行うことは脳卒中の発生率を減らし結果を改善するために不可欠です

研究の目的:

急性不全性脳卒中 (AIS) と一時性不全性脳卒中 (TIA) の治療に関する根拠に基づいたガイドラインを概説する.
TIAまたは軽度のAIS後の再発性脳卒中の予防における二重抗血小板治療の有効性を要約する.
AISの無効化のために,IVアルテプラスと機械的血栓切除を含む再注血療法の利点を検討する.

主な方法:

臨床試験とTIAとAISの治療ガイドラインのレビュー
二重抗血小板療法 (アスピリンとクロピドグレル) の有効性に関するデータの分析
AIS患者の静脈内複合組織プラズミノゲン活性化剤 (IV rtPA) と機械的血栓切除に関連するアウトカムの評価.

主要な成果:

3週間の二重抗血小板治療は,選択された高リスクのTIAと軽度のAIS患者の脳卒中リスクを低下させる (7. 8%から5. 2%).
症状の発症から4. 5時間以内に投与された場合,rtPAはAISを無効化する機能的アウトカムを改善します.
6~24時間以内のメカニカル・トロンベクトミーは,大血管閉塞によるAISを無効化する機能的独立性を有意に高めます.

結論:

24時間以内に二重抗血小板治療を開始することは,選択されたTIAおよび軽度の脳卒中患者にとって有効です.
血栓解剖と機械的血栓切除は,AISの無効化における機能的結果を改善するための重要な介入です.
脳卒中の影響を軽減するには適時かつ適切な治療戦略が不可欠です

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