脳梗塞急性期の血行再建術の意義

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Today, there is no established therapy for acute ischemic stroke. Acute ischemic stroke is now generally accepted as progressive process, so it is important to prevent the brain from converting into irreversible states, in the period when the brain are functionally supressed but not infarcted. So this rationale, when it is supported by experimental and clinical data, suggests that direct revascularization might alleviate some ischemic strokes.<BR>Two patients with middle cerebral artery occlusion were presented. We divided acute ischemic stroke into following three stages : First stage-it is the period soon after onset of a stroke and neurological deficits are evident but CT scanning indicates no abnomality. In some cases, revascularization can lead a substantial improvement; Second stage-it is the period of cerebral edema. CT scanning discloses low density area (LDA) with a mass effect. Main therapy should be focused upon the control of intracranial pressure; Third stage-it is completed infarct. CT scanning clearly demonstrates a well-circumscribed LDA.. Bypass or carotid surgery can prevent reccurrent ischemic stroke in some cases.<BR>Our experience with surgical treatment of acute strokes has shown some conclusions and problems. Indications for revascularization are suggested when the following clinical criteria are satisfied: The patients should be rather young. The patient should be alert and not so severe in motor disturbance. Anterior choroidal or lenticulostriate arteries should be patent. Emergent revascularization in acute stroke awaits further development methods to differentiate ischemia from infarct, to prolong a reversible state by the administration of brain protective drugs such as barbiturate, and to perform a rapid and high flow revascularization.

脳梗塞急性期の血行再建術の意義

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