急性期脳梗塞患者の脳循環代謝動態の評価と血行再建術の適応について

抄録

We sought to assess ischemic tissue reversibility by SPECT or diffusion/perfusion MRI in acute ischemic stroke patient who performed successful thrombolytic therapy. We had 546 consecutive cases of acute ischemic stroke in our hospital last year. Thrombolytic therapy was performed in 32 patients (22 in intraarterial thromblysis and 10 in intravenous t-PA) who had diffusion/perfusion mismatch within 6 hours from symptom onset. In patients who had successful vessel recanalization with treatment, relative ADC lesioncontralateral normal region ratios was obtains in the following regions : 1) infarct core with hyperintensity on DWI, abnormality on PWI and follow-up abnormality, 2) non-infarcted penumbra with abnormality on DWI and PWI, and normal follow-up and 3) hypoperfused tissue that remained viable with normal DWI, abnormal PWI and normalfollow-up. Fifteen patients with early vessel recanalization were studied. Mean time from symptom onset to recanalization was 5.1 hours. Within 4 hours from symptom onset, no regions of interest with an ADC ratio more than 0.8 infarcted. Between 4 hours and 7 hours, regions of interest with ADC of 0.8-0.9 showed viable or infacrtion. Evaluation of ischemic threshold measured by ADC ratio may provide important information for clinical decision making of thrombolytic therapy.