REPERFUSION AFTER THROMBOLYTIC THERAPY IN ISCHEMIC STROKE MEASURED BYSINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY

Background and Purpose We used Tc-99m-hexamethylpropyleneamine oxime s ingle-photon emission computed tomography (SPECT) to study cerebral pe rfusion in patients treated with streptokinase for acute ischemic stro ke in an open and prospective study. Our primary aims were (1) to comp are the extent of reperfusion between patients who had received thromb olytic 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. Methods Fifty-seve n patients (22 treated with streptokinase) had two SPECT studies perfo rmed, the first before streptokinase administration and the second 24 hours later. Results On the first SPECT study hypoperfusion was presen t in the middle cerebral artery or anterior cerebral artery territorie s in 40 patients (17 treated with streptokinase). Patients in the trea tment and control groups with initial hypoperfusion on SPECT were well matched for the volume of the perfusion defect and the severity of ne urological deficit. A greater number of patients who received streptok inase developed at least partial reperfusion (streptokinase, 65%; cont rol, 52%) on the second study but not significantly so (P=.43). Simila rly, the proportion of each hypoperfused region that reperfused (P=.74 ) and the reduction in the size of the perfusion defect (P=.06) were h igher in the streptokinase group but did not reach statistical signifi cance. When ali 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 r eperfusion or normal perfusion initially. Conclusions These findings s uggest that at least some reperfusion during the first 48 hours of isc hemic stroke is a common natural occurrence and is of prognostic signi ficance. The observed trend toward better reperfusion indexes among pa tients treated with streptokinase is encouraging, but larger controlle d trials are required to answer this definitively.