Document Detail

Spontaneous reperfusion after ischemic stroke is associated with improved outcome.
MedLine Citation:
PMID:  9836763     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The rationale behind thrombolytic therapy in acute ischemic stroke is penumbral salvage by rapid restoration of cerebral blood flow. The relationship, however, between early reperfusion (potentially composed of both nutritional and nonnutritional components) and outcome remains unclear.
METHODS: To establish the relationship between reperfusion parameters and outcome variables (Canadian Neurological Scale, Barthel Index, outcome CT scans), we used 99Tc-hexamethylpropyleneamine oxime (99Tc-HMPAO) single-photon emission CT (SPECT) to examine 41 acute ischemic stroke patients. All patients had at least 2 SPECT studies (24 with 3 studies), and none had been treated with thrombolytic or other acute investigational drugs.
RESULTS: A total of 106 studies were performed. Mean time to acute study was 9.2 hours; that for subacute study was 42 hours and for outcome study was 150 days. Hypoperfusion (HP) volumes at each of the 3 time points correlated with outcome clinical state and final infarct size. Both early reperfusion (61% of patients) and nutritional reperfusion alone (56%), which is early reperfusion maintained at outcome, were associated with improvement in clinical state and better functional outcome. Early HP volume change (acute minus subacute HP volume) and total HP volume change (acute minus outcome HP volume) also correlated with clinical improvement and better outcome.
CONCLUSIONS: This study establishes the benefit of spontaneous reperfusion after ischemic stroke and emphasizes the prognostic value of HP deficit volumes. 99Tc-HMPAO SPECT may be used to screen patients and group them according to perfusion deficit in acute stroke trials, thereby decreasing patient numbers required to show drug effect.
P A Barber; S M Davis; B Infeld; A E Baird; G A Donnan; D Jolley; M Lichtenstein
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  29     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1999-01-08     Completed Date:  1999-01-08     Revised Date:  2014-02-06    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2522-8     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Brain Ischemia / physiopathology*,  radionuclide imaging
Cerebrovascular Circulation / physiology*
Cerebrovascular Disorders / physiopathology*,  radionuclide imaging
Middle Aged
Nutritional Physiological Phenomena / physiology
Radiopharmaceuticals / diagnostic use
Technetium Tc 99m Exametazime / diagnostic use
Time Factors
Tomography, Emission-Computed, Single-Photon
Reg. No./Substance:
0/Radiopharmaceuticals; 100504-35-6/Technetium Tc 99m Exametazime
Comment In:
Stroke. 1999 Aug;30(8):1733-4   [PMID:  10436132 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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