Reperfusion and metabolic recovery of brain tissue and clinical outcome after ischemic stroke and thrombolytic therapy

Background and Purpose-It is unclear from recent clinical trials whether th rombolytic agents are capable of facilitating reperfusion and metabolic rec overy over time or whether a beneficial effect is counteracted by an increa se in the risk of brain hemorrhage. We studied the effect of thrombolytic t reatment on metabolic recovery after reperfusion and clinical outcome. Methods-Patients were prospectively studied with Tc-99m-ethyl cysteinate di mer single photon emission computed tomography (Tc-99m-ECD-SPECT) before tr eatment with recombinant tissue plasminogen activator (rTPA; 0.9 mg/kg TV; n=26) or placebo (n=26) 6 to 8 hours after treatment and at 7+/-1 days. Act ivity deficits were graded, compared between the treatment groups, and corr elated with clinical outcome and the incidence of brain hemorrhage, Metabol ic recovery of ischemic brain tissue was defined as a 25% decrease on the S PECT graded scale. Results-Patients with metabolic recovery (n=28) had a better chance of bein g functionally unimpaired 3 months after stroke than patients without recov ery (n=24) (OR 4.5, 95% CI 1.09 to 18.89) and had smaller infarcts on follo w-up CT (36+/-38 versus 167+/-162 mt), regardless of whether metabolic reco very was observed within 6 to 8 hours of treatment or at 7 days. None of th e 28 patients with metabolic recovery had a fatal parenchymal hemorrhage ve rsus 5 of 24 patients without recovery (P=0.016). Treatment did not affect the incidence of brain tissue metabolic recovery. Conclusions-Brain tissue metabolic recovery after ischemic stroke was assoc iated with a beneficial effect on clinical outcome and was not facilitated by treatment with 0.9 mg of intravenous rTPA.