Prediction of acute embolic stroke outcome after local intraarterial thrombolysis: Value of pretreatment and posttreatment Tc-99m-ethyl cysteinate dimer single photon emission computed tomography
K. Ogasawara et al., Prediction of acute embolic stroke outcome after local intraarterial thrombolysis: Value of pretreatment and posttreatment Tc-99m-ethyl cysteinate dimer single photon emission computed tomography, J CEREBR B, 20(11), 2000, pp. 1579-1586
The aim of this study was to investigate the efficacy of pre- and posttreat
ment Tc-99m-ethyl cysteinate dimer (Tc-99m-ECD) single photon emission comp
uted tomography (SPECT) for predicting the ischemic outcome of embolic midd
le cerebral artery occlusion after treatment with local intraarterial throm
bolysis. The authors examined 28 patients with a moderately ischemic area (
ratio of affected regional activity to cerebellar activity (A/C ratio) of 0
.4 to 0.7) determined using pretreatment SPECT, and with complete recanaliz
ation within 6 hours. Posttreatment dynamic and static SPECT studies were p
erformed immediately after thrombolysis. The extent of the affected area ou
tlined on pretreatment SPECT was used for the posttreatment SPECT images, a
nd AIC ratios were calculated. The relative retention ratio of Tc-99m-ECD i
n the affected area was also analyzed using posttreatment dynamic SPECT. Fo
ur-teen patients either without infarction or with small subcortical and ba
sal ganglial infarction, 11 patients with medium or large cortical infarcti
on, and 3 patients with hemorrhage were identified by follow-up computed to
mography. Ischemic outcome correlated with the relative retention ratio of
Tc-99m-ECD more closely than either the pre- or posttreatment A/C ratios. I
n particular, a threshold value for the development of hemorrhage was disti
nct only in the relative retention ratio of Tc-99m-ECD. Pretreatment Tc-99m
-ECD SPECT did not always predict the occurrence of hemorrhagic transformat
ion, whereas dynamic Tc-99m-ECD SPECT performed immediately after thromboly
sis allowed clear identification of patients at risk for hemorrhagic transf
ormation.