虚血性脳血管障害の治療 : 血液希釈療法および血行再建術併用療法

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Superficial temporal artery-middle cerebral artery bypass surgery (STA-MCA bypass) has been widely accepted as an effective treatment for ischemic cerebrovascular disease in terms of improvement of cerebral blood flow in the ischemic region. However, an indication and timing of bypass surgery for patients with ischemic stroke is still obscure. Isovolemic hemodilution was performed in 35 cases with cerebral ischemia within 72 hours of the onset of symptoms and resulted in an increase of the regional cerebral blood flow (rCBF) by 29.8% in the area supplied by the affected MCA, leading to rapid neurological improvement in 26 cases. These 26 cases then randomly assinged to acute bypass group (16 cases) that STA-MCA bypass was performed within 3 days after hemodilution, or to delayed group (10 cases) that bypass was performed at more than 30 days after hemodilution. In acute group, rCBF of the affected MCA region increased by 9% and neurological score (NS) improved by 8% at one month after the bypass surgery. In the delayed group, at one month after the hemodilution, rCBF of the affected MCA region and NS had returned to levels close to those observed before hemodilution. STA-MCA bypass did not increase the rCBF of affected MCA region nor bring the neurological improvement in the delayed group. In conclusion 1) Isovolemic hemodilutional therapy has been shown to raise collateral perfusion to acutely ischemic brain regions distal to occluded cerebral arterlies. 2) 72% of treated patients showed rapid neurological improvement, suggesting an effectiveness of isovolemic hemodilution as a preoperative prediction of ischemic penumbra. 3) The patients, whose NS responded well by hemodilution therapy, took a good neurological recovery following bypass surgery in the acute stage, whereas bypass surgery in the chronic stage did not bring on a good recovery.
神戸大学の論文

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頃末和良
神戸大学医学部脳神経外科学講座

虚血性脳血管障害の治療 : 血液希釈療法および血行再建術併用療法

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