脳血行再建術と出血性梗塞

概要

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Fifty five patients with recanalized infarction were studied to clarify the mechanism of hemorrhagic infarction (HI) after revascularization. Hemorrhagic infarction appeared in 25 patients (46%) from 2nd to 30th day of stroke. There were two types of HI; the acute type with brain edema (12 cases), and the subacute type with positive contrast enhancement (CE) on CT (14 cases). Positive CE usually preceeded to the appearance of HI, which suggests the close correlation between the mechanism of positive CE and HI.<BR>In 95 patients who were performed extra-intracranial arterial bypass (EIAB) surgery, HI was presented in three patients postoperatively. In these cases, the timing of operation was 2nd day, 8th day and 29th day of stroke respecively. Hypertensive treatment was also performed before or after surgery in two of those cases. One of these three cases with HI had a fatal course.<BR>This fact gives a warning for reconstructive surgery in the cases with a large low density area on CT in acute and subacute stage (stage of positive CE on CT, namely within 5 weeks after the onset). Induced hypertention after surgery seems to be contraindicated in these cases.
The Japanese Society on Surgery for Cerebral Strokeの論文