Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography

This study investigates retrospectively, in selected patients, the ischemic outcome (reversible ischemia, infarction, and hemorrhage) and neurologic o utcome of acute stroke treated with intra-arterial thrombolysis and the pre dictive value of pretreatment single-photon emission-computed tomography (S PECT). Thirty patients with complete recanalization within 12 hours were an alyzed. The extent of ischemia was outlined on SPECT, and two CBF parameter s were calculated: the ratio of ischemic regional activity to CBF in the ce rebellum and the asymmetry index. Reversible ischemia, infarction, and hemo rrhage were identified by comparing SPECT and follow-up computed tomography . Nine patients (30%) had no or small infarction, 14 (47%) had medium or la rge infarction, and seven (23%) had hemorrhage. Forty-two lesions were iden tified (22 reversible ischemia, 13 infarction, and 7 hemorrhage). Duration of ischemia, urokinase dose, disease type, and occlusion site were nonsigni ficant factors, whereas neurologic outcome and CBF parameters were signific ant among the three patient groups and three types of ischemic lesions. Isc hemic tissue with CBF greater than 55% of cerebellar flow still may be salv age able, even with treatment initiated 6 hours after onset of symptoms. Is chemic tissue with CBF greater than 35% of cerebellar flow still may be sal vageable with early treatment (less than 5 hours). Ischemic tissue with wit h CBF less than 35% of cerebellar flow may be at risk for hemorrhage within the critical time window. Pretreatment SPECT can provide useful parameters to increase the efficacy of thrombolysis by reducing hemorrhagic complicat ions and improving neurologic outcome.