急性脳血管症候群としての一過性脳虚血発作

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Transient ischemic attacks (TIAs) are well known as prodromal indicators of ischemic stroke. However, patients within the early period after TIA are insufficiently recognized to have a very high risk of stroke. Therefore, TIAs in acute settings should be treated as medical emergencies. TIAs are not differentiated from acute ischemic stroke (AIS), only by the duration of the symptoms. A TIA in an acute setting and an AIS is in the same acute ischemic syndrome spectrum. Thus, we proposed a new concept, termed acute cerebrovascular syndrome (ACVS) that includes TIA in acute settings and AIS. Immediate evaluation and treatment initiation in a TIA clinic that can see patients 24 hours/day, 365 days/year has been reported to be very effective in reducing the risk of stroke in the early period following a TIA. TIA patients with high clinical risk scores, including ABCD2 score; positivity by diffusion weighted imaging; intracranial or extracranial arterial stenosis; multiple episodes of TIA, including crescendo TIA; and hypercoagulability, such as antiphospholipid syndrome, should be admitted, and undergo immediate brain and vascular imaging. Blood tests and cardiac evaluations should also be performed to detect vascular and cardiac risk factors. After immediate examinations, antithrombotic therapy and risk factor management with antihypertensives, statins, and glucose-lowering drugs is required. Dual antiplatelet therapy in patients with non-cardioembolic TIAs for aggressive inhibition of platelet activation, and novel oral anticoagulants, for rapid inhibition of coagulation activation in patients with cardioembolic TIA due to atrial fibrillation, may be effective for preventing early recurrence of stroke. In addition, surgical or intravascular interventions, such as carotid endarterectomy, stenting, or bypass surgery, should be considered for patients resistant to medical treatment.
2014-01-31

著者

内山真一郎
東京女子医科大学

急性脳血管症候群としての一過性脳虚血発作

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