THROMBOLYTIC THERAPY IN ACUTE ISCHEMIC STROKE - A DANISH PILOT-STUDY

Background and Purpose: In a feasibility and safety study of thromboly tic therapy in acute ischemic stroke, we explored the usefulness of me asurements of regional cerebral blood flow. Methods: Twenty-three pati ents with acute ischemic stroke were treated with 100 mg recombinant t issue plasminogen activator infused intravenously over 1 hour. Thrombo lytic therapy was initiated 78 to 355 minutes after onset of symptoms. Results: Angiography 16 to 24 hours after treatment in 17 patients sh owed patent intracranial arteries in 12, partial occlusion of the midd le cerebral artery in 3, and total occlusion of the middle cerebral ar tery in 2. rCBF with Tc-99m-hexamethylpropyleneamine oxime intravenous ly was measured 5 minutes before and within 24 hours after thrombolyti c therapy in 12 patients. 10 of the 12 patients showed brain tissue re perfusion and 2, with angiographically documented middle cerebral arte ry occlusion, showed no reperfusion, thus documenting a relationship b etween reperfusion measured by regional cerebral blood flow and angiog raphic patency (P=.015). Three patients died. Patients who were reperf used within 24 hours (documented by repeated regional cerebral blood f low measurements) showed greater clinical improvement on the Scandinav ian Stroke Scale the sooner their thrombolytic therapy was started and the more severe their neurological deficits. Conclusions: Acute cereb ral ischemia can be documented by rCBF measurements without delay of t hrombolytic therapy, and repeated rCBF measurements can reveal whether cerebral reperfusion has occurred. In our study, early reperfusion wa s associated with clinical improvement.