Reperfusion after thrombolytic therapy in ischemic stroke measured by single-photon emission computed tomography.

Baird, Alison E.; Donnan, Geoffrey A; Austin, Mark C.; Fitt, Gregory J; Davis, Stephen M.; McKay, W J

doi:10.1161/01.str.25.1.79

Cited by 88 publications

(65 citation statements)

References 25 publications

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“…78 In addition, pericyte death in rigor results in a permanent decrease in blood flow in capillaries and damages neurons after stroke. [94][95][96] These mechanisms resemble FIR in improving capillary dilation and blood flow and may reflect the promotion of stroke recovery by FIR stimulation. In other words, FIR therapy may alleviate stroke by inhibiting pericyte death.…”

Section: Discussionmentioning

confidence: 95%

RETRACTED: Far-infrared therapy for cardiovascular, autoimmune, and other chronic health problems: A systematic review

Shui

Wang

Chiang

et al. 2015

Exp Biol Med (Maywood)

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Physical therapy (physiotherapy), a complementary and alternative medicine therapy, has been widely applied in diagnosing and treating various diseases and defects. Increasing evidence suggests that convenient and non-invasive far-infrared (FIR) rays, a vital type of physiotherapy, improve the health of patients with cardiovascular disease, diabetes mellitus, and chronic kidney disease. Nevertheless, the molecular mechanisms by which FIR functions remain elusive. Hence, the purpose of this study was to review and summarize the results of previous investigations and to elaborate on the molecular mechanisms of FIR therapy in various types of disease. In conclusion, FIR therapy may be closely related to the increased expression of endothelial nitric oxide synthase as well as nitric oxide production and may modulate the profiles of some circulating miRNAs; thus, it may be a beneficial complement to treatments for some chronic diseases that yields no adverse effects.

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Section: Discussionmentioning

confidence: 95%

RETRACTED: Far-infrared therapy for cardiovascular, autoimmune, and other chronic health problems: A systematic review

Shui

Wang

Chiang

et al. 2015

Exp Biol Med (Maywood)

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“…90 Recanalization and reperfusion status were fairly correlated in the other three patients, and one additional patient had undergone partial reperfusion despite unsuccessful recanalization. 90 In another study, which compared the efficacy of intravenous streptokinase against placebo, out of 10 patients with initial vessel occlusion, 4 had successful recanalizaton, yet impaired reperfusion. 91 Reperfusion and recanalization were correlated in the remaining eight patients; six attained successful recanalization and reperfusion, whereas the remaining two reached neither end point.…”

Section: Can We Improve the Stroke Outcome After Thrombolysis?mentioning

confidence: 77%

“…90,91 In one study, out of five patients with an initial perfusion defect on serial single photon emission CT together with an intracranial artery occlusion, one patient had no cerebral reperfusion despite partial recanalization of MCA with intraarterial streptokinase. 90 Recanalization and reperfusion status were fairly correlated in the other three patients, and one additional patient had undergone partial reperfusion despite unsuccessful recanalization. 90 In another study, which compared the efficacy of intravenous streptokinase against placebo, out of 10 patients with initial vessel occlusion, 4 had successful recanalizaton, yet impaired reperfusion.…”

Section: Can We Improve the Stroke Outcome After Thrombolysis?mentioning

confidence: 99%

“…91 Both studies showed that perfusion status, rather than successful or unsuccessful recanalization, had a significant impact on clinical outcome at follow-up. 90,91 These studies were followed by analyses carried out in cohorts of patients receiving intravenous or intraarterial tPA in the acute ischemic stroke setting. In the International Management of Stroke-I (IMS-I) trial, which tested the efficacy and safety of intravenous and intraarterial tPA combination therapy, digital subtraction angiography was used for assessing both recanalization and reperfusion.…”

Section: Can We Improve the Stroke Outcome After Thrombolysis?mentioning

confidence: 99%

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Can Restoring Incomplete Microcirculatory Reperfusion Improve Stroke Outcome after Thrombolysis?

Dalkara

Arsava

2012

J Cereb Blood Flow Metab

208

182

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Substantial experimental data and recent clinical evidence suggesting that tissue reperfusion is a better predictor of outcome after thrombolysis than recanalization necessitate that patency of microcirculation after recanalization should be reevaluated. If indeed microcirculatory blood flow cannot be sufficiently reinstituted despite complete recanalization as commonly observed in coronary circulation, it may be one of the factors contributing to low efficacy of thrombolysis in stroke. Although microvascular no-reflow is considered an irreversible process that prevents tissue recovery from injury, emerging evidence suggests that it might be reversed with pharmacological agents administered early during recanalization. Therefore, therapeutic approaches aiming at reducing microvascular obstructions may improve success rate of recanalization therapies. Importantly, promoting oxygen delivery to the tissue, where entrapped erythrocytes cannot circulate in capillaries, with ongoing serum flow may improve survival of the underreperfused tissue. Altogether, these developments bring about the exciting possibility that benefit of reperfusion therapies can be further improved by restoring microcirculatory function because survival in the penumbra critically depends on adequate blood supply. Here, we review the available evidence suggesting presence of an ‘incomplete microcirculatory reperfusion’ (IMR) after focal cerebral ischemia and discuss potential means that may help investigate IMR in stroke patients after recanalization therapies despite technical limitations.

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“…Although the number of patients included in this study is very small, the data are consistent with clinical response observed in our patients and with other studies of cerebral perfusion and thrombolysis in the literature. [3][4][5] One implication of our study is that clinical criteria alone without confirmatory measurement of cerebral perfusion is sufficient to establish that most patients who qualify for rtPA therapy on clinical grounds also have a significant cerebral ischemic lesion. The patient population in this SPECT study did not include those with brain stem infarcts but did include patients suspected of having either cortical or lacunar hemispheric strokes.…”

Section: Discussionmentioning

confidence: 87%

tPA-Associated Reperfusion After Acute Stroke Demonstrated by SPECT

Grotta

Alexandrov

1998

Stroke

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Purpose-The aim of our study was twofold: to determine the frequency and magnitude of perfusion defect in stroke patients who qualify for rtPA therapy within 3 hours of stroke onset and to determine the ability of rtPA to improve perfusion by 24 hours. Subjects and Methods-Patients with suspected hemispheric stroke who fulfilled entry criteria into the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study and also had pretreatment injection of 99m Tc-HMPAO, with single-photon emission computed tomography (SPECT) performed using a triple-head camera at baseline and 24 hours, were included. Results-All 12 patients who qualified for rtPA therapy had perfusion defects on baseline SPECT (SPECT graded scale [SGS] score range, 16 to 79). MeanϮSD perfusion defect was comparable in rtPA (nϭ4)versus placebo (nϭ5) A lthough rtPA therapy within the first 3 hours after the onset of acute stroke symptoms results in improved outcome, the urgency of this therapy precludes extensive diagnostic studies before treatment. Therefore, in the NINDS study that demonstrated the efficacy of rtPA, there was no requirement to demonstrate a perfusion defect prior to treatment. Furthermore, while it is assumed that the effectiveness of rtPA was due to its ability to improve reperfusion during the immediate poststroke period, this was not documented by comparing baseline with 24-hour studies of cerebral blood flow in the rtPA versus placebo groups. At our center, which was one of the participants in the NINDS rt-PA Stroke Study, we tried to obtain SPECT cerebral perfusion studies at baseline and after 24 hours in as many patients as possible during the study. We report the baseline results in all 12 patients who had SPECT scans carried out within 3 hours of symptom onset and the baseline compared with 24-hour SPECT studies in all 5 placebo-treated and 4 rtPA-treated patients. Subjects and Methods Selection of PatientsAll patients admitted to Hermann Hospital (Houston, Tex), where we carried out the NINDS rtPA study, were considered for inclusion.The inclusion and exclusion criteria for the NINDS study have been published 1 and for the most part were the inclusion and exclusion criteria for the present SPECT analysis, because all patients studied with SPECT were being considered simultaneously for inclusion into the NINDS rtPA trial. In addition, to be included in this SPECT substudy, all patients had to receive the injection of isotope ( 99m Tc-HMPAO) for SPECT within 3 hours of symptom onset but before rtPA administration, all had to have technically adequate SPECT scans carried out at baseline and again after 24 hours, and all had to have suspected hemispheric infarcts. Of the 12 patients meeting these criteria and included in this analysis, 8 were randomized into the NINDS rtPA versus placebo study and one was treated with openlabel rtPA soon after the study was completed. Three were not treated with thrombolytics. Some of these patients were included in a previous publication 2 that validated our SPECT meth...

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Reperfusion after thrombolytic therapy in ischemic stroke measured by single-photon emission computed tomography.

Cited by 88 publications

References 25 publications

RETRACTED: Far-infrared therapy for cardiovascular, autoimmune, and other chronic health problems: A systematic review

RETRACTED: Far-infrared therapy for cardiovascular, autoimmune, and other chronic health problems: A systematic review

Can Restoring Incomplete Microcirculatory Reperfusion Improve Stroke Outcome after Thrombolysis?

tPA-Associated Reperfusion After Acute Stroke Demonstrated by SPECT

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