(Stroke. 1999;30:678-680.)
© 1999 American Heart Association, Inc.
Case Report |
Intra-Arterial rtPA Treatment of Stroke Assessed by Diffusion- and Perfusion-Weighted MRI
From the Stanford Stroke Center (M.G.L., D.C.T., M.A.Y.) and the Stanford Department of Radiology (A.M.N., M.E.M.), UCSF Stanford Health Care, Palo Alto, Calif.
Correspondence to David C. Tong, MD, Stanford Stroke Center, Building B, Suite 325, 701 Welch Rd, Palo Alto, CA 94304-1705. E-mail dct{at}leland.stanford.edu
Background—Diffusion-weighted MRI (DWI) and perfusion-weighted MRI (PWI) are new techniques that can be used for the evaluation of acute ischemic stroke. However, their potential role in the management of patients treated with recombinant tissue plasminogen activator (rtPA) has yet to be determined.
Case Description—The authors present the case of a 73-year-old man who was treated with intra-arterial rtPA, and they compare findings on DWI and PWI scans with angiography. PWI revealed decreased cerebral perfusion corresponding to an area that was not successfully recanalized, but revealed no abnormality in regions in which blood flow was restored. DWI was unremarkable in the region that was reperfused early (3 hours) but revealed hyperintensity in an area that was reperfused 3.5 hours after symptom onset and in the area that was not reperfused.
Conclusions—Findings on PWI correlated well with angiography, and DWI detected injured tissue in the hyperacute stage, whereas conventional MRI findings were negative. This suggests that these techniques may be useful to noninvasively evaluate the success of thrombolytic therapy.
Key Words: angiography • diagnostic imaging • plasminogen activator, tissue type • stroke management
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