中大脳動脈Ｍ１閉塞症における局所線溶療法の治療成績―閉塞部位による検討―

Abstract

We performed intraarterial thrombolysis in 36 patients with evolving acute cerebral infarction due to occlusion of the middle cerebral artery (MCA). Angiographic sites of arterial occlusion were divided into 3 types: 1) M1 proximal occlusion type, MCA trunk occlusion proximal to the lenticulostriate arteries (16 patients), 2) M1 middle portion occlusion type, MCA trunk occlusion with partial involvement of the lenticulostriate arteries (9 patients), and 3) M1 distal occlusion type, MCA trunk occlusion distal to the lenticulostriate arteries (11 patients). The modified Rankin Scale (mRS) was used to assess clinical outcome at discharge. The rate of partial or complete recanalization in the proximal occlusion group was 44%, that in the middle portion occlusion group was 67%, and that in the distal occlusion group was 73%. There were trends toward the better recanalization rate in distal occlusions. Excellent or good outcome (mRS score 0 to 2) was seen in 13% of patients in the proximal occlusion group, 45% of those in the middle portion occlusion group, and 73% of those in the distal occlusion group. There was a significantly higher incidence of functionally independent patients in the distal occlusion group (p<0.05). Symptomatic cerebral hemorrhage occurred in 5 patients (14%). Intraarterial thrombolysis for acute middle cerebral artery occlusion is a very effective treatment modality for the M1 distal occlusion patients. But in M1 proximal occlusion patients, the recanalization rate is low, and the outcome is significantly poor even in the patients who underwent recanalization. Therefore we should consider intraarterial thrombolysis for the patients with the involvement of the lenticulostriate arteries.