Stroke, Vol 25, 298-303, Copyright © 1994 by American Heart Association
T Ueda, T Hatakeyama, Y Kumon, S Sakaki and T Uraoka
BACKGROUND AND PURPOSE: Thrombolytic therapy was carried out on patients
with acute ischemic stroke, and the risk of hemorrhagic transformation was
evaluated from the residual cerebral blood flow (CBF) by pretherapeutic
single-photon emission-computed tomography (SPECT). METHODS: Local
intra-arterial thrombolytic therapy was carried out using urokinase or
recombinant tissue plasminogen activator (rt-PA) within 6 hours from the
onset in 34 patients in whom no hypodensity areas were observed on the
initial computed tomography examination. In the 20 patients with carotid
territory occlusion who underwent 99mTc- labeled hexamethylpropyleneamine
oxime (99mTc-HMPAO) SPECT, the residual CBF of the ischemic region was
evaluated semiquantitatively by calculating two parameters: the ischemic
regional activity to cerebellar activity ratio (R/CE ratio) and asymmetry
index (AI). RESULTS: The occluded vessels could be recanalized in 22 (92%)
of the 24 patients in the urokinase group and in all 10 of the patients in
the rt-PA group. Hemorrhagic transformation appeared in 4 patients in the
urokinase group and 3 patients in the rt-PA group. Among the 20 patients
who underwent SPECT before the treatment, the residual CBF was lower in the
5 patients who developed hemorrhagic transformation than in the 15 who did
not (P < .05). Hemorrhagic transformation occurred in all patients with
R/CE ratio of less than 0.35 and AI of more than 1.5. CONCLUSIONS: The risk
of hemorrhagic transformation after recanalization of occluded vessels by
local intra-arterial thrombolytic therapy was considered to be high when
the pretherapeutic residual CBF was markedly reduced.
ARTICLES
Evaluation of risk of hemorrhagic transformation in local intra- arterial thrombolysis in acute ischemic stroke by initial SPECT
Department of Neurological Surgery, Ehime University School of Medicine, Japan.
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