臨床神経学

第49回日本神経学会総会

<シンポジウム1-1>脳血管障害:基礎と臨床の最前線
「血栓溶解療法が拓く脳卒中新時代」

峰松 一夫

国立循環器病センター内科脳血管部門〔〒565-8565 大阪府吹田市藤白台5-7-1〕

Japan Alteplase Clinical Trial (J-ACT), a prospective multicenter clinical trial, demonstrated good clinical outcome in patients treated with 0.6 mg/kg of alteplase, being similar to that with 0.9 mg/kg of alteplase in the National Institute of Neurological Disorders and Stroke (NINDS) study. On that basis, intravenous aplteplase therapy was approved in Japan in October, 2005. This therapy resulted in better efficacy and similar safety in our stroke care unit (SCU) as compared to J-ACT or other clinical studies performed outside Japan. Our nation-wide survey demonstrated that the approval of the therapy resulted in dramatic changes in the processes of management for acute stroke patients. Preliminary results of the post-marketing surveillance study of alteplase in Japan suggested similar efficacy and safety profiles of the therapy to those reported by a European study, Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST).
There are several limitations and problems in the therapy that will be overcome by new therapeutic strategies including the development of new-generation therombolytic agents having longer therapeutic time window, applications of magnetic resonance imaging techniques, and combination therapies with neuroprotective agents, sonothrombolysis, intraarterial application of the agent, or mechanical thrombectomy.
Full Text of this Article in Japanese PDF (390K)

(臨床神経, 48:889−891, 2008)
key words:遺伝子組み換え組織型プラスミノゲン・アクティベータ, 一次脳卒中センター, 急性虚血性脳血管障害, 病院前脳卒中救護, 脳卒中ユニット

(受付日:2008年5月16日)