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Title: Reperfusion after thrombolytic therapy in ischemic stroke measured by single-photon emission computed tomography.
Austin Authors: Baird, A E;Donnan, Geoffrey A ;Austin, M C;Fitt, Gregory J ;Davis, S M;McKay, W J
Affiliation: Department of Neurology, Austin Hospital, Victoria, Australia
Issue Date: 1-Jan-1994
Publication information: Stroke; A Journal of Cerebral Circulation; 25(1): 79-85
Abstract: We used 99mTc-hexamethylpropyleneamine oxime single-photon emission computed tomography (SPECT) to study cerebral perfusion in patients treated with streptokinase for acute ischemic stroke in an open and prospective study. Our primary aims were (1) to compare the extent of reperfusion between patients who had received thrombolytic therapy and a control group studied during the same period who were ineligible to receive such therapy and (2) to determine if, among all patients, reperfusion led to improved outcome.Fifty-seven patients (22 treated with streptokinase) had two SPECT studies performed, the first before streptokinase administration and the second 24 hours later.On the first SPECT study hyperfusion was present in the middle cerebral artery or anterior cerebral artery territories in 40 patients (17 treated with streptokinase). Patients in the treatment and control groups with initial hypoperfusion on SPECT were well matched for the volume of the perfusion defect and the severity of neurological deficit. A greater number of patients who received streptokinase developed at least partial reperfusion (streptokinase, 65%; control, 52%) on the second study but not significantly so (P = .43). Similarly, the proportion of each hypoperfused region that reperfused (P = .74) and the reduction in the size of the perfusion defect (P = .06) were higher in the streptokinase group but did not reach statistical significance. When all patients were considered, those who did not reperfuse had higher mortality rates (P = .008), less neurological improvement (P = .016), and more functional disability (P < .001) than patients who had reperfusion or normal perfusion initially.These findings suggest that at least some reperfusion during the first 48 hours of ischemic stroke is a common natural occurrence and is of prognostic significance. The observed trend toward better reperfusion indexes among patients treated with streptokinase is encouraging, but larger controlled trials are required to answer this definitively.
Gov't Doc #: 8266387
Journal: Stroke
Type: Journal Article
Subjects: Aged
Brain Ischemia.physiopathology.radionuclide imaging.therapy
Cerebral Angiography
Cerebrovascular Disorders.physiopathology.radionuclide imaging.therapy
Nervous System.physiopathology
Organotechnetium Compounds.diagnostic use
Oximes.diagnostic use
Pilot Projects
Streptokinase.therapeutic use
Subtraction Technique
Survival Analysis
Technetium Tc 99m Exametazime
Thrombolytic Therapy
Tomography, Emission-Computed, Single-Photon
Treatment Outcome
Appears in Collections:Journal articles

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