STREPTOKINASE IN ACUTE STROKE - EFFECT ON REPERFUSION AND RECANALIZATION

The Australian Streptokinase Trial was a randomized, double-blind, pla cebo-controlled trial, in which streptokinase (SK, 1.5 million IU TV) was given within 4 hours of stroke onset. In a subset of 37 patients, Tc-99m-labeled D,L-hexamethylpropylene amine oxime single-photon emiss ion computed tomography (SPECT) and/or transcranial Doppler (TCD) stud ies were performed before and after therapy to test the hypothesis tha t SK may improve the hemodynamic measures of reperfusion/recanalizatio n rates (TCD parameter) within 24 hours. Eighteen patients received SK and 19 placebo. Baseline characteristics were similar in both groups, and there were no differences in clinical outcomes assessed at 3 mont hs after stroke. Although there was no increase in the group mean perf usion defect or volume on SPECT after thrombolytic therapy, a larger n umber of patients demonstrating the combined end point of reperfusion or recanalization was seen in the SK group (13/14, 93%) than in the pl acebo group (7/14, 50%; p = 0.01). Although SK given within 4 hours of acute ischemic stroke appears to improve arterial patency/tissue repe rfusion, this effect is neither early nor extensive enough to influenc e overall clinical outcome.