STREPTOKINASE INCREASES LUXURY PERFUSION AFTER STROKE

Background and Purpose Recent acute stroke trials have reported that i ntravenous streptokinase is associated with an increased risk of adver se outcomes. We aimed to study the effect of streptokinase on the natu re of reperfusion and the relation between reperfusion and clinical ou tcome. Methods We studied 24 patients in the Australian Streptokinase Trial with acute middle cerebral cortical infarction using Tc-99m-hexa methylpropyleneamine oxime single-photon emission CT. Eleven of the 24 patients were scanned before therapy and again 24 hours later. The re maining 13 were scanned once either before therapy (1 patient) or afte r therapy (12 patients). All patients had outcome scans after 3 months . Infarct hypoperfusion was measured with a validated volumetric techn ique. Neurological impairment and functional outcome were assessed wit h the Canadian Neurological Scale and the Barthel Index, respectively. Results Fifteen patients received streptokinase and 9 received placeb o. There was no difference in early reperfusion between streptokinase and placebo. However, streptokinase was associated with a greater amou nt of nonnutritional reperfusion than was placebo (P=.04). This luxury perfusion was associated with poor functional outcome (P=.02). Conclu sions This study suggests that streptokinase augments luxury perfusion after stroke. Luxury perfusion is associated with a worse outcome, wh ich might be due in part to reperfusion injury.