Purpose:To prospectively compare therapeutic and hemorrhagic effects of microplasmin and tissue plasminogen activator (tPA) in stroke therapy by using multiparametric magnetic resonance (MR) imaging in a photothrombotic rat stroke model.
Materials and Methods:The animal experiment complied with institutional regulations for laboratory animals. Stroke was induced in rats with photothrombotic occlusion of middle cerebral artery (MCA). T2-weighted, perfusion-weighted (PW), and diffusion-weighted (DW) MR imaging was performed 1 hour and 24 hours after occlusion. On the basis of PW and DW images at 1 hour, 49 rats with cortex and subcortex involvement and with perfusion-diffusion mismatch were randomly assigned into one of four groups: control group, group treated with 7.5 mg microplasmin, group treated with 10 mg/kg microplasmin, or group treated with 10 mg/kg tPA. Agents were intravenously injected 1.5 hours after occlusion. Infarct size and hemorrhagic transformation were assessed with MR imaging and histomorphologic findings. Neurologic deficit was scored. Measurements were statistically analyzed.
Results:There were 13 rats in the control group, 13 in the 7.5 mg/kg microplasmin group, nine in the 10 mg/kg microplasmin group, and 14 in the 10 mg/kg tPA group. Despite similar baseline perfusion-diffusion mismatch, histochemically defined total infarct volume was reduced from 25% Ϯ 5 (standard deviation) in control group to 21% Ϯ 2, 20% Ϯ 4, and 20% Ϯ 5 in 7.5 mg/kg microplasmin, 10 mg/kg microplasmin, and tPA groups, respectively, as similarly shown on T2-weighted, DW, and PW images at 24 hours (P Ͻ .05). Cerebral hemorrhage rate at 24 hours was higher in tPA group than in the other three groups. Bederson score of neurologic deficits was significantly reduced in treated groups compared with that in control group.
Conclusion:Perfusion-diffusion mismatch appeared useful in selecting candidates for thrombolytic therapy. Multiparametric MR imaging allowed noninvasive assessment of effects of microplasmin and tPA in rats; microplasmin had a significantly lower hemorrhagic rate. Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article.
Tissue plasminogen activator (tPA) has shown therapeutic effects for the treatment of acute ischemic stroke in both animals (1,2) and patients (3,4). Results of some studies (5-7) indicate that tPA may increase the risk of hemorrhagic transformation, especially in cases of blood-brain barrier perturbation before tPA administration (5,6) and in cases of delayed (4 -6 hours) tPA treatment (5,8). In patients who received tPA, the incidence of symptomatic hemorrhage showed a 10-fold increase compared with that in a placebo group (3,9); however, there is still controversy about the adverse effects of tPA (10,11). Therefore, efforts have been made to develop new thrombolytic agents that may improve the benefit-to-risk ratio in the management of strok...