［総説］破裂脳動脈瘤塞栓術後のくも膜下出血に伴う脳血攣縮に対する新しい治療法の開発

概要

論文の詳細を見る
To prevent vasospasm in patients with ruptured aneurysms who had undergone Guglielmi detachable coil (GDC) placement, we developed our ITSUKI (intrathecal simple administration of urokinase infusion) therapy and kit (ITSUKIT) for performing of ITSUKI.Here we present the effectiveness of this therapy in preventing the severity of ischemic neurological deficits attributable to vasospasm. After evaluating the effectiveness of ITSUKI therapy in a canine subarachnoid hemorrhage (SAH) model, we performed clinical trials.At 24 hr after SAH induction, we injected urokinase (UK. 1000 IU/kg) into the cisterna magna (CM) or lumbar sac (LS) of dogs via a microcatheter inserted in the lumbar region. We then obtained serial angiograms over a 14-day period and chronologically examined the changes in the mean diameter of the basilar artery (BA) to determine the effect of different injection sites on vasospasm prevention. In our canine SAH model, the administration of UK into the CM was significantly more effective for preventing cerebral vasospasms than was administration into the LS. We enrolled 20 patients with ruptured intracranial aneurysms who were eligible for coil embolization with (n=10) or without (n=10) ITSUKI therapy. There were no side effects or adverse reactions attributable to ITSUKI therapy. Symptomatic vasospasm occurred in 1 (10.0%) patients with and 5 (50.0%) without ITSUKI therapy; the difference was significant (p<0.05). Although the mortality rate did not differ between the 2 groups, patients with ITSUKI therapy had significantly better outcomes than those without (p<0.05). No complication was observed according to ITSUKIT and it was useful for ITSUKI therapy.

［総説］破裂脳動脈瘤塞栓術後のくも膜下出血に伴う脳血攣縮に対する新しい治療法の開発

スポンサーリンク

概要

著者

関連論文

スポンサーリンク