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(Stroke. 1999;30:787-792.)
© 1999 American Heart Association, Inc.

Original Contributions

Extracorporeal Rheopheresis in the Treatment of Acute Ischemic Stroke

A Randomized Pilot Study

Jörg Berrouschot, MD; Henryk Barthel, MD; Johannes Köster, MD; Swen Hesse, MD; Annegret Rössler, MD; Wolfram H. Knapp, MD Dietmar Schneider, MD

From the Departments of Neurology (J.B., J.K., A.R., D.S.) and Nuclear Medicine (H.B., S.H.), University of Leipzig, and the Department of Nuclear Medicine, Hannover Medical School (W.H.K.) (Germany).

Correspondence to Jörg Berrouschot, MD, Department of Neurology, University of Leipzig, Liebigstrasse 22a, 04103 Leipzig, Germany. E-mail berj{at}medizin.uni-leipzig.de

Background and Purpose—Extracorporeal rheopheresis is a safe method to optimize hemorheology. Our aim was to determine whether treatment with extracorporeal rheopheresis in patients with acute ischemic hemispheric stroke improves cerebral perfusion as assessed with serial ^99mTc–ethyl-cysteinate-dimer single-photon emission CT (^99mTc-ECD SPECT). We also investigated how clinical outcome is associated with treatment and imaging results.

Methods—Thirty-three patients (mean age, 64±10 years) with acute ischemic hemispheric stroke were included in a prospective, randomized, parallel group pilot study. First treatment with or without extracorporeal rheopheresis took place within 12 hours after the onset of symptoms and was repeated 3 times at intervals of 24 hours. Hemorheological parameters were measured before and after each session. Each patient underwent ^99mTc-ECD SPECT immediately before treatment, 6 to 8 hours after treatment, and after 5 days. A semiquantitative SPECT graded scale was used to measure depth and extent of activity deficits and thus to quantify the perfusion deficit.

Results—Seventeen patients were actively treated with extracorporeal rheopheresis, and 16 patients did not receive extracorporeal rheopheresis. After 3 months, no differences were found in the functional or neurological outcome. Despite a rapid, sustained decrease of plasma viscosity and erythrocyte aggregation in the rheopheresis group, there was no significant difference in the SPECT graded scale after therapy between the 2 groups. Patients with early reperfusion (decrease in the SPECT graded scale >25% 6 to 8 hours after therapy compared with the baseline examination) experienced a better functional outcome (Modified Rankin Scale) after 3 months compared with patients without reperfusion (P=0.04).

Conclusions—Since quantitative flow mapping and clinical follow-up did not reveal any differences between patients who were treated with extracorporeal rheopheresis and controls, it appears very unlikely that extracorporeal rheopheresis enhances reperfusion after acute cerebral ischemia.

Key Words: rheology • stroke, ischemic • tomography, emission computed • viscosity

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