Recently, it has been widely reported that thrombolytic therapy could be effective in acute ischemic stroke. We reported relations of cerebral blood flow (CBF) using 133Xe-SPECT and cerebral infarction (CI) on CT/MRI in patients treated with local thrombolytic therapy (LTT).
Thirty-three patients with middle cerebral artery (MCA) stem or trunk occlusion were treated with LTT from 1991 to 1997. The outcome (GOS) of these patients was GR in 26 patients, MD in 2, SD in 4, and Dead in 1. We annalyzed various factors in retrospect view, as follows;
1. NIHSS, Barthel index and modified Rankin scale in day 30th were compared to the grade of immediate recanalization after the treatment by angiography, then, there was no significant difference among them.
2. Pre- and post-treated CBF were evaluated before and after LTT. Mean CBF was measured in anterior and posterior MCA areas without immediate recanalization (28 areas of total 57 areas). Of these 28 non-recanalized area, pre-CBF in areas without CI (n=15) and pre-CBF in areas with CI (n=13) was not significantly different, however, post-CBF in areas without CI (30.3±5.1 ml/100 g/min) was significantly higher than post-CBF in areas with CI (23.3±4.4 ml/100 g/min) (p=0.0008). In areas with increased CBF (postCBF-preCBF≥5ml/100g/min, n=11 areas), CI appeared 2 areas (19%). In areas without increased CBF (postCBF-preCBF<5 ml/100 g/min, n=17 areas), 17 areas (65%) developed CI.
It was suggested that the outcome in patients without immediate recanalization after LTT could be improved by not only improvement of collateral flow but also early recanalization in following period. Conversely, when arterial occlusion was persisted over 8 hours, areas with CBF less than about 27 ml/ 100 g/min could develop CI.
