부산대학교 도서관

We determined the selection criteria for intra-arterial thrombolytic therapy by initial single-photon emission-computed tomography (SPECT) using 99mTc-HMPAO. We studied 30 patients who were obtained early complete recanalization of the internal carotid territory occlusion. The residual CBF of non-infarction, infarction and hemorrhagic lesions judged by follow-up CT scan was evaluated semiquantitatively by calculating two parameters with pretherapeutic SPECT: the ischemic regional activity to cerebellar activity ratio (R/CE ratio) and asymmetry index (AI). The patient's neurological exam was evaluated according to the NIH stroke scale score. The patients were classified by follow-up CT into three groups: A) nine patients who had no or small infarction; B) fourteen patients who had medium or large cortical infarction; C) seven patients who had hemorrhagic transformation. No significant difference was observed in the interval from onset, UK doses, or site of occlusion between each group. However, the residual CBF and the NIH scores 1 month later in group C were significantly worse than those in group A or B. Forty-two lesions were identified (22 reversible ischemia, 13 infarction, and 7 hemorrahge). The residual CBF and neurological outcome were significant among three types of lesions. Tissue reversibility at any given time rather than duration of ischemia remains the most important factor to influence outcome. Pretreatment SPECT can assess tissue reversibility and increase the efficacy of intra-arterial thrombolysis for acute stroke patients.