From the Stroke Program, Department of Neurology, University of Texas
Health Science Center, Houston, Tex.
Correspondence to James C. Grotta, MD, Department of Neurology, Rm 7.044, University of Texas Health Science Center, 6431 Fannin, Houston, TX 77030. E-mail jgrotta{at}neuro.med.uth.tmc.edu
Purpose—The aim of our study was
twofold: to determine the frequency and magnitude of perfusion defect
in stroke patients who qualify for rtPA therapy within 3 hours of
stroke onset and to determine the ability of rtPA to improve perfusion
by 24 hours.
Subjects and Methods—Patients with suspected hemispheric stroke
who fulfilled entry criteria into the National Institute of
Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study and also
had pretreatment injection of 99mTc-HMPAO, with
single-photon emission computed tomography (SPECT) performed using a
triple-head camera at baseline and 24 hours, were included.
Results—All 12 patients who qualified for rtPA therapy had
perfusion defects on baseline SPECT (SPECT graded scale [SGS] score
range, 16 to 79). Mean±SD perfusion defect was comparable in rtPA
(n=4)versus placebo (n=5) groups (SGS score, 36±18 versus 39±12; NS)
despite earlier injection time in the rtPA group (98±24 versus 141±21
minutes; P=.02). Total SPECT scanning time was 20 to 25
minutes. At 24 hours, reperfusion was greater in rtPA patients compared
with the placebo group (SGS score, 7±9 versus 29±17;
P=.05), with relative improvement in the
region-of-interest scores of 87±16% after rtPA compared with 28±30%
with placebo (P=.01).
Conclusions—A substantial perfusion defect exists in stroke
patients with larger hemispheric infarcts who meet NINDS criteria for
rtPA therapy, and rtPA is better able than placebo to rectify this
defect. SPECT is feasible for clinical trials and should be evaluated
as a substituted end point in stroke therapeutic trials.
© 1998 American Heart Association, Inc.
Original Contributions
tPA-Associated Reperfusion After Acute Stroke Demonstrated by SPECT
Key Words: cerebral blood flow • plasminogen activator, tissue-type • reperfusion • stroke • tomography, emission computed
This article has been cited by other articles:
 |
|
 |
|
  G. Tsivgoulis and A. Alexandrov Ultrasound-Enhanced Thrombolysis: From Bedside to Bench Stroke, May 1, 2008; 39(5): 1404 - 1405. [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Noser, H. M. Shaltoni, C. E. Hall, A. V. Alexandrov, Z. Garami, E. D. Cacayorin, J. K. Song, J. C. Grotta, and M. S. Campbell III Aggressive Mechanical Clot Disruption: A Safe Adjunct to Thrombolytic Therapy in Acute Stroke? Stroke, February 1, 2005; 36(2): 292 - 296. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Alexandrov, C. E. Hall, L. A. Labiche, A. W. Wojner, and J. C. Grotta Ischemic Stunning of the Brain: Early Recanalization Without Immediate Clinical Improvement in Acute Ischemic Stroke Stroke, February 1, 2004; 35(2): 449 - 452. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Brown, K. C. Johnston, D. P. Wagner, and E. C. Haley Jr Predicting Major Neurological Improvement With Intravenous Recombinant Tissue Plasminogen Activator Treatment of Stroke Stroke, January 1, 2004; 35(1): 147 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
R. E. Latchaw, H. Yonas, G. J. Hunter, W. T.C. Yuh, T. Ueda, A. G. Sorensen, J. L. Sunshine, J. Biller, L. Wechsler, R. Higashida, et al. Guidelines and Recommendations for Perfusion Imaging in Cerebral Ischemia: A Scientific Statement for Healthcare Professionals by the Writing Group on Perfusion Imaging, From the Council on Cardiovascular Radiology of the American Heart Association Stroke, April 1, 2003; 34(4): 1084 - 1104. [Full Text] [PDF]
|
|
|
|
 |
|
 C Foerch, R Du Mesnil de Rochemont, O Singer, T Neumann-Haefelin, M Buchkremer, F E Zanella, H Steinmetz, and M Sitzer S100B as a surrogate marker for successful clot lysis in hyperacute middle cerebral artery occlusion J. Neurol. Neurosurg. Psychiatry, March 1, 2003; 74(3): 322 - 325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Lapchak, D. M. Araujo, D. Song, and J. A. Zivin The Nonpeptide Glycoprotein IIb/IIIa Platelet Receptor Antagonist SM-20302 Reduces Tissue Plasminogen Activator-Induced Intracerebral Hemorrhage After Thromboembolic Stroke Stroke, January 1, 2002; 33(1): 147 - 152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Molina, J. Montaner, S. Abilleira, J. F. Arenillas, M. Ribo, R. Huertas, F. Romero, and J. Alvarez-Sabin Time Course of Tissue Plasminogen Activator-Induced Recanalization in Acute Cardioembolic Stroke: A Case-Control Study Stroke, December 1, 2001; 32(12): 2821 - 2827. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C. Grotta, K. M. A. Welch, S. C. Fagan, M. Lu, M. R. Frankel, T. Brott, S. R. Levine, P. D. Lyden, and P. D. Lyden Clinical Deterioration Following Improvement in the NINDS rt-PA Stroke Trial Stroke, March 1, 2001; 32(3): 661 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Keris, S. Rudnicka, V. Vorona, G. Enina, B. Tilgale, and J. Fricbergs Combined Intraarterial/Intravenous Thrombolysis for Acute Ischemic Stroke AJNR Am. J. Neuroradiol., February 1, 2001; 22(2): 352 - 358. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Lapchak, D. F. Chapman, and J. A. Zivin Pharmacological Effects of the Spin Trap Agents N-t-Butyl-Phenylnitrone (PBN) and 2,2,6,6-Tetramethylpiperidine-N-Oxyl (TEMPO) in a Rabbit Thromboembolic Stroke Model : Combination Studies With the Thrombolytic Tissue Plasminogen Activator Stroke, January 1, 2001; 32(1): 147 - 153. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Brott and J. Bogousslavsky Treatment of Acute Ischemic Stroke N. Engl. J. Med., September 7, 2000; 343(10): 710 - 722. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Rother, L. Jonetz-Mentzel, A. Fiala, J. R. Reichenbach, M. Herzau, W. A. Kaiser, and C. Weiller Hemodynamic Assessment of Acute Stroke Using Dynamic Single-Slice Computed Tomographic Perfusion Imaging Arch Neurol, August 1, 2000; 57(8): 1161 - 1166. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Berrouschot, H. Barthel, S. Hesse, W. H. Knapp, D. Schneider, and R. von Kummer Reperfusion and Metabolic Recovery of Brain Tissue and Clinical Outcome After Ischemic Stroke and Thrombolytic Therapy Stroke, July 1, 2000; 31(7): 1545 - 1551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. S. Burgin, M. Malkoff, R. A. Felberg, A. M. Demchuk, I. Christou, J. C. Grotta, and A. V. Alexandrov Transcranial Doppler Ultrasound Criteria for Recanalization After Thrombolysis for Middle Cerebral Artery Stroke Stroke, May 1, 2000; 31(5): 1128 - 1132. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. V. Alexandrov, A. M. Demchuk, R. A. Felberg, I. Christou, P. A. Barber, W. S. Burgin, M. Malkoff, A. W. Wojner, and J. C. Grotta High Rate of Complete Recanalization and Dramatic Clinical Recovery During tPA Infusion When Continuously Monitored With 2-MHz Transcranial Doppler Monitoring Stroke, March 1, 2000; 31(3): 610 - 614. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.-D. Heiss, L. Kracht, M. Grond, J. Rudolf, B. Bauer, K. Wienhard, and G. Pawlik Early [11C]Flumazenil/H2O Positron Emission Tomography Predicts Irreversible Ischemic Cortical Damage in Stroke Patients Receiving Acute Thrombolytic Therapy Stroke, February 1, 2000; 31(2): 366 - 369. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Demchuk, T. H. Wein, R. A. Felberg, I. Christou, and A. V. Alexandrov Evolution of Rapid Middle Cerebral Artery Recanalization During Intravenous Thrombolysis for Acute Ischemic Stroke Circulation, November 30, 1999; 100(22): 2282 - 2283. [Full Text] [PDF]
|
|
|
|
 |
|
 A. V. Alexandrov and J. W. Norris SPECT in cerebrovascular disease Can. Med. Assoc. J., November 1, 1999; 161(9): 1135 - 1135. [Full Text] [PDF]
|
|
|
|
|
|
T. Ueda, S. Sakaki, Y. Kumon, and S. Ohta Multivariable Analysis of Predictive Factors Related to Outcome at 6 Months After Intra-Arterial Thrombolysis for Acute Ischemic Stroke Stroke, November 1, 1999; 30 (11): 2360 - 2365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Berrouschot, H. Barthel, J. Koster, S. Hesse, A. Rossler, W. H. Knapp, and D. Schneider Extracorporeal Rheopheresis in the Treatment of Acute Ischemic Stroke : A Randomized Pilot Study Stroke, April 1, 1999; 30(4): 787 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Demchuk, R. A. Felburg, and A. V. Alexandrov Clinical Recovery from Acute Ischemic Stroke after Early Reperfusion of the Brain with Intravenous Thrombolysis N. Engl. J. Med., March 18, 1999; 340(11): 894 - 895. [Full Text]
|
|
|
|
|
|
P. Pantano, F. Caramia, L. Bozzao, C. Dieler, and R. von Kummer Delayed Increase in Infarct Volume After Cerebral Ischemia : Correlations with Thrombolytic Treatment and Clinical Outcome Stroke, March 1, 1999; 30(3): 502 - 507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Barber, S. M. Davis, B. Infeld, A. E. Baird, G. A. Donnan, D. Jolley, and M. Lichtenstein Spontaneous Reperfusion After Ischemic Stroke Is Associated With Improved Outcome Stroke, December 1, 1998; 29(12): 2522 - 2528. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Meyer, J. Grotta, and A. Alexandrov Quantitative Brain SPECT and the NIH Stroke Scale • Response Stroke, July 1, 1998; 29(7): 1480 - 1480. [Full Text]
|
|