徳島大学病院脳卒中センターでの内頸動脈急性閉塞に対する治療戦略

Objective : Strokes related to acute internal carotid artery （ICA） occlusion are associated with extremely poor prognosis. Recently, some studies have reported that the prognosis has been getting better by treating with intra-arterial endovascular therapy. We sought to evaluate clinical outcomes in patients with acute ischemic stroke attributable to ICA occlusion treated with intraarterial endovascular therapy or otherwise.
Methods : We reviewed ４４ patients who underwent treatment with intra-arterial endovascular therapy or otherwise in our stroke care unit （SCU） from January, ２０１１ to May, ２０１４. We compared the prognosis of patients in the ２ treatment groups （endovascular group, n＝２３ vs nonendovascular group, n＝２１）.
Results : The rate of good prognosis （modified Rankin Score of ≦２） was significantly higher in the endovascular group than non-endovascular group （１７．４％ vs０％，p＝０．０４５）. The rate of patients who had extreme improvements of National Institutes of Health Stroke Scale （NIHSS） ≧８ was higher in the endovascular group than non-endovascular group （３０．４％ vs１４．３％）. Concerning the improvement of NIHSS ≧８, recombinant tissue-type plasminogen activator （rt-PA） or the left side ICA occlusion were associated significantly （p＝０．０１９, p＝０．０４２, respectively）. Although the hypothesis that endovascular therapy could contribute to extreme improvements of NIHSS wasn’t proved （p＝０．２０２）, there was one case that NIHSS was dramatically improved from ２２ to ０ by endovascular therapy.
Conclusions : Intra-arterial endovascular therapy of ICA occlusion might result in improved clinical outcomes for indicated cases.