Symposium 13

3月27日［土］09:45-11:15

 
  Novel cardiovascular approaches for stroke prevention by multidisciplinary brain-heart team
  
 
   
  脳卒中における心原性脳塞栓症の割合は比較的高く、その臨床的意義は梗塞範囲が大きくなる傾向から高い。心臓に塞栓子を発生しうる基礎心疾患を有する患者は、脳卒中の既往に関わらず適切な予防が重要である。このように交差する脳と心疾患のニーズから、両領域の医師を含む多職種による医療介入、すなわちブレインハートチームによる新たなアプローチが広まりつつある。特に二次予防の場合、脳卒中が「塞栓症」であったのかにより、治療ストラテジーそのものが著しく異なる。全身抗凝固療法がファーストラインに位置づけられ、新規抗凝固薬が患者満足度や安全性を向上させてきた。然るに、出血合併症などにより、これらの長期内服が困難な患者が一定頻度で存在し、薬物の代替療法が開発されてきた。近年、カテーテルインターベンションの発達、心臓外科手術の低侵襲化から、特に脳卒中と関係の深い心臓構造である左心耳や卵円孔のマネジメントが、薬物の代替治療として確立してきた。本シンポジウムでは、脳卒中予防対策として登場した、これら心臓構造をターゲットとする新たな医療を中心に、「ブレインハートチーム」という視点を重視し、循環器内科医、心臓外科医、脳卒中医によるクロストークを展開したい。正確な心原性脳塞栓の診断、デバイス医療、手術、画像活用などをテーマとした最新の研究報告を要望したい。
Proportion of cardiogenic embolization is relatively high in overall stroke, in which clinical significance become more significant due to its tendency of larger ischemic areas. Patients complicated with underlying cardiac diseases that may cause intracardiac embolus must require adequate preventive therapy regardless with history of stroke. Because of such crossing demands between brain and heart, new cardiovascular approaches by multidisciplinary medical intervention, so called “brain-heart team”, gradually become popular. Especially, in cases with secondary prevention of stroke, treatment strategies depend on accurate diagnosis of “embolization” for initial cerebrovascular event by neurologists. Systemic anticoagulant therapy is considered as first line therapy for prevention, and novel anticoagulant agents have altered patients’ satisfaction as well as safety. However, there is an unneglectable proportion of patients for whom continuation of oral anticoagulation is problematic due to bleeding complications, which demands alternative approaches instead of medication. In these days, thanks to developments of catheter intervention and less invasive cardiac surgery, managements of relevant cardiac structures like left atrial appendages and patent forameno vale become available as such alternative treatment. In this symposium, we would like to discuss on novel cardiovascular approaches targeting such cardiac structures, taking cross talk by the multidisciplinary staff including cardiologists, cardiac surgeon, and neurologists, focusing on “brain-heart team” approaches. We welcome the abstracts of new researches especially regarding with theme of accurate diagnosis of cardiac embolization, therapeutic challenges with devices and surgery for relevant cardiac structures, and utilization of images for such treatment.
 
 
   
 
 
Yoshihiro Morino   Yoshihiro Morino
Department of Cardiology, Iwate Medical University, Morioka
   Mamoo Nakamura   Mamoo Nakamura
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
 
 
 
 
   
 
 
Mamoo Nakamura   Mamoo Nakamura
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, USA
   Yasuhide Mochizuki   Yasuhide Mochizuki
Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo
 
 
 
Hidehiko Hara   Hidehiko Hara
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo
   Yoshiharu Higuchi   Yoshiharu Higuchi
Cardiovascular Division, Osaka Police Hospital, Osaka