title: Diagnostic impact of baseline cerebral blood flow in patients with acute ischemic stroke prior to intravenous recombinant tissue plasminogen activator therapy.
abstract: OBJECTIVE
  To determine whether severe cerebral perfusion defects measured by SPECT prior to rt-PA therapy attribute to severe intracerebral hemorrhage (SICH).
  
  
  METHODS
  We measured baseline cerebral blood flow (CBF) using technetium-99m-labeled hexamethylpropyleneamine oxime (99mTc-HMPAO) SPECT qualitatively prior to rt-PA therapy, in 52 consecutive patients (range 38-93 years). The degree and extent of the asymmetry of local CBF were analyzed semi-quantitatively. We did not administrate rt-PA in patients with severe perfusion defects. Clinical outcome and the incidence of SICH were studied.
  
  
  RESULTS
  Three (5.8%) patients had severe perfusion defects that were undetected by CT and/or DWI. The other 49 (94.2%) patients had mild perfusion defects. The asymmetry of local CBF was 0.08±0.08 (n=3) and 0.3±0.15 (n=49) in the two groups, respectively. The percentages of the ipsilateral hemisphere in which perfusion was impaired severely were 17.5±9.5% (n=3) and 0.43±0.87% (n=49). Two patients were found petechial hemorrhage, but there was no patient who developed SICH in the former group following conventional antithrombotic therapy. In the latter group, SICH occurred in 1/49 (2.0%) patient following rt-PA therapy.
  
  
  CONCLUSIONS
  These results suggest that rt-PA therapy for patients with severe cerebral perfusion defects may cause SICH and baseline CBF may contribute to identify patients at high risk for SICH after intravenous rt-PA therapy.
authors: Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, E1-15-7-20, Tsukisamu, Toyohira-ku, Sapporo 062-8513, Japan. masakiitou-nsu@umin.ac.jp
authors: Masaki
authors: M
authors: Ito
authors: Tetsuyuki
authors: T
authors: Yoshimoto
authors: Masahito
authors: M
authors: Kawabori
authors: Shin
authors: S
authors: Fujimoto
authors: Tohru
authors: T
authors: Yamauchi
authors: Hideshi
authors: H
authors: Yamaguchi
authors: Kouichi
authors: K
authors: Tokuda
authors: Sadao
authors: S
authors: Kaneko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019275:Radiopharmaceuticals; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D019690:Technetium Tc 99m Exametazime; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D010959:Tissue Plasminogen Activator
keywords: 99mTc-HMPAO SPECT; Acute ischemic stroke; Hemorrhagic transformation; Tissue plasminogen activator