초록 ▼

본 중개연구는 초급성 뇌경색의 혈전용해술 연구와 급성기 뇌경색 MRI 병변 재발 연구로 대별된다. 발병시간이 불명확한 환자에서 MRI 기준을 적용하였을 때 혈전용해술이 안전하고 효과적임을 입증하였다. 동맥을 통한 혈전용해술의 재개통 시기가 빠를수록 예후는 좋았으며, 지연 재개통군에서 재개통 시기를 앞당길 수 있는 방법의 개선이 필요함을 보였다. 혈전용해술 후 뇌출혈 발생을 예측하는 MRI 인자는 DWI의 급성 뇌경색 영역에 존재하는 국소적 FLAIR 변화였다. 뇌졸중 아형에 따른 MRI 뇌경색 재발 연구에서 두개강내 혈관질환의 MR

본 중개연구는 초급성 뇌경색의 혈전용해술 연구와 급성기 뇌경색 MRI 병변 재발 연구로 대별된다. 발병시간이 불명확한 환자에서 MRI 기준을 적용하였을 때 혈전용해술이 안전하고 효과적임을 입증하였다. 동맥을 통한 혈전용해술의 재개통 시기가 빠를수록 예후는 좋았으며, 지연 재개통군에서 재개통 시기를 앞당길 수 있는 방법의 개선이 필요함을 보였다. 혈전용해술 후 뇌출혈 발생을 예측하는 MRI 인자는 DWI의 급성 뇌경색 영역에 존재하는 국소적 FLAIR 변화였다. 뇌졸중 아형에 따른 MRI 뇌경색 재발 연구에서 두개강내 혈관질환의 MRI 재발은 두개강외 혈관질환이나 심인성 색전에 비해 더 흔하고 임상적 재발을 더 잘 유발하였다. 다중 뇌순환 다발성 뇌경색의 발생에는 여러 기전들이 혼합되어 있었고, 전신적 염증 반응이 발병에 중요한 역할을 하고 있었다. MRI 뇌경색 병변 재발에는 D-dimer 상승이 독립적인 위험인자였다. 이상의 연구결과들을 토대로 초급성 뇌경색의 혈전용해술의 효과 및 부작용과 급성기 뇌경색 MRI 병변 재발에 관여하는 인자를 규명하고 MRI 소견을 임상치료에 응용하려는 본래의 목적을 달성하였다고 본다.

Abstract ▼

This translational research comprises thrombolysis research in hyperacute stroke and MRI recurrence research in acute stage of stroke.
In thrombolysis research in hyperacute stroke, this project aimed to elucidate factors associated with recanalization and intracerebral hemorrhage after thromboly

This translational research comprises thrombolysis research in hyperacute stroke and MRI recurrence research in acute stage of stroke.
In thrombolysis research in hyperacute stroke, this project aimed to elucidate factors associated with recanalization and intracerebral hemorrhage after thrombolytic treatments, and to apply MRI markers for the thrombolytic treatment of unclear-onset stroke. Between 32 patients with unclear onset and 223 patients with clear onset, the rates of recanalization, intracerebral hemorrhage, and 7-day and 3-month function outcomes were not different each other. This observation suggests that thrombolysis based on MRI criteria may safely be applied to acute stroke patients with unclear onset. In the study investigating the relationship between recanalization and outcome after intra-arterial thrombolysis, the earlier the recanalization was accomplished, the better the functional outcome. Patients with recanalization had more frequent cardioembolism and middle cerebral artery occlusion than those without. However, there was no clinical and radiological difference between patients with immediate recanalization and those with delayed recanalization. This suggests that more efficient thrombolytic strategies are required to improve outcome in delayed recanalizagtion group. In the study investigating the MRI variables associated with the most serious complication after thrombolysis, i.e., intracerebral hemorrhage, the presence of focal FLAIR hyperintensity within the area of acute DWI lesions independently predicted occurrence of thrombolysis-related intracerebral hemorrhage.
In MRI recurrence research, this project aimed to elucidate the differential patterns of MRI recurrence according to stroke subtypes and to identify novel hematologic factors associated with the MRI recurrence. MRI recurrence in intracranial large artery atherosclerosis had the following characteristics: it occurred mostly in the pial area of the same vascular territory as the index stroke; it was more frequently observed in a higher grade of stenosis than in milder stenosis; it was not associated with subsequent recanalization contrary to cardioernbolism; and it was more closely associated with clinical recurrence. The study investigating the mechanism of acute multiple infarcts in multiple cerebral circulations shows that their stroke mechanisms are heterogeneous and that systemic inflammation may be associated with their pathogenesis, because C-reactive protein was significantly higher in patients with multiple circulation strokes than those without. In the study to identify novel hematologic risk factors associated with early recurrence on MRI, D-dimer independently predicted the MRI lesion recurrence. This observation suggests that thrombin generation and fibrin turnover are elevated in patients with MRI recurrence. Further research is required to determine whether patients with elevated D-dimer benefit from treatments aimed at modifying hemostatic function.
Based on the results described above, this project fulfill the goal to identify factors associated with the efficacy and complication of thrombolysis and with the MRI lesion recurrence, and to apply MRI markers to broaden therapeutic time windows in the acute stroke treatment.

목차 Contents

• 표지 ...1
• 제출문 ...2
• I. 총괄현황 ...3
• 보고서 요약서 ...4
• 한글요약문 ...5
• SUMMARY ...6
• 연구 성과 실적 및 향후 계획 ...8
• 참여연구원 현황표 ...26
• II. 총괄연구과제 연구결과...27
• 1. 연구개발과제의 배경 및 필요성...2
• 2. 국내외 기술개발 현황...29
• 3. 연구개발과제의 추진체계...30
• 4. 연구개발수행 내용 및 결과...31
• 5. 목표달성도 및 관련분야 기여도...40
• 6. 향후 연구성과 추진 계획...40
• 7. 연구개발결과의 파급효과...41
• 8. 연구개발결과의 활용계획...41
• 9. 연구개발과정에서 수집한 해외과학기술정보...41
• 10. 참고문헌...41
• IV. 첨부서류...43
• 1. 자체평가의견서...44
• 2. 연구성과 실적 증빙서류...48
• 3. 기타 요청서류...48
• [양식 2] 최종보고서 평가 면제요청서(중개연구 논문성과 달성)...49