Abstract
To clarify the clinical significance of local fibrinolytic therapy for acute ischemic stroke, patients with major artery occlusion were analyzed in respect to cerebral blood flow (CBF) and somatosensory evoked potentials (SEP). In 41 patients SEP was monitored and in 18 patients CBF was measured by SPECT using HMPAO and assessed semiquantitatively: multiple regions of interest (ROIs) were placed on the section images, and R/L ratio was calculated (where R represents a mean count of the ROI in the affected hemisphere, L on the opposite side).
Reperfusion significantly reduced the development of infarction in the ROI with an R/L ratio between 0.65 and 0.85. No correlation was observed between the development of infarction and the duration of ischemia. R/L ratio correlated significantly with N19 and central conduction time. The R/L ratio in the patients with N19 negative was far below the critical value of 0.65-0.85. The rate of recanalization, the size of infarction, and the outcome of the patients with N19 positive were higher, smaller, and better than those of the patients with N19 negative. The present study shows that reperfusion achieved by fibrinolytic therapy in the acute stage can prevent ischemia in a limited blood flow value, and SEP could be a good indicator to evaluate the ischemic level.
