Differences in clot preparation determine outcome of recombinant tissue plasminogen activator treatment in experimental thromboembolic stroke.
OBJECTIVE
Thrombin-induced clots used in experimental thromboembolic stroke differ from clots forming spontaneously under clinical conditions. We investigated whether this difference influences the efficacy and outcome of thrombolytic treatment.


METHODS
In rats, the middle cerebral artery was occluded by intracarotid injection of fibrin-rich clots, prepared either according to established methods by adding thrombin to freshly drawn arterial blood or by spontaneous coagulation. The mechanical properties of clots were determined in vitro by elasticity and plasticity tests. One hour after embolism, thrombolysis was started by intra-arterial application of recombinant tissue plasminogen activator (rtPA) (10 mg/kg). Treatment efficacy was monitored by MR measurements of blood perfusion, apparent diffusion coefficient (ADC), T2 relaxation time and blood-brain barrier permeability, and by pictorial measurements of ATP and pH.


RESULTS
Thrombin-induced clots were classified as elastic, and spontaneously forming clots were classified as plastic. Middle cerebral artery embolism with thrombin-induced or spontaneously forming clots led to similar reduction of perfusion and ADC, but rtPA treatment efficacy differed greatly. In the spontaneously forming clot group, blood perfusion returned to or above control within 2 hours, ADC and ATP normalized, tissue pH exhibited alkalosis, and T2 and blood-brain barrier permeability did not change. In the thrombin-induced clot group, in contrast, blood reperfusion was delayed, ADC and ATP remained reduced, tissue pH was acidic, and edema developed, as reflected by increased T2 and blood-brain barrier permeability.


CONCLUSIONS
rtPA-induced thrombolysis promotes rapid reperfusion and tissue recovery in animals embolized with spontaneously forming clots but not in those embolized with thrombin-induced clots. This difference is explained by the different mechanical and possibly molecular consequences of clot preparation and must be considered for the interpretation of thrombolysis experiments.
Niessen
Frank
F
Department of Experimental Neurology, Max-Planck-Institute for Neurological Research, Gleueler Strasse 50, D-50931 Cologne, Germany.
Hilger
Thomas
T
Hoehn
Mathias
M
Hossmann
Konstantin-A
KA
D000255:Adenosine Triphosphate / Q000378:metabolism; D000818:Animals; D001812:Blood-Brain Barrier / Q000187:drug effects; D001921:Brain / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004195:Disease Models, Animal; D018450:Disease Progression; D004548:Elasticity; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005337:Fibrin / Q000008:administration & dosage / Q000096:biosynthesis / Q000737:chemistry; D019786:Gadolinium DTPA; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D020767:Intracranial Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D015424:Reperfusion / Q000379:methods; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013917:Thrombin; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D011994:Recombinant Proteins; D000255:Adenosine Triphosphate; D005337:Fibrin; D013917:Thrombin; D010959:Tissue Plasminogen Activator; D019786:Gadolinium DTPA