Brain single-photon emission CT with HMPAO and safety of thrombolytic therapy in acute ischemic stroke

Proceedings of the meeting of the SPECT Safe Thrombolysis Study Collaborators and the members of the Brain Imaging Council of the Society of Nuclear Medicine

Andrei V. Alexandrov, Joseph C. Masdeu, Michael D. Devous, Sandra E. Black, James C. Grotta

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: To reliably identify patients at risk for symptomatic hemorrhagic transformation (SHT), future trials of thrombolysis for acute ischemic stroke might use a vascular imaging protocol applicable to a multicenter setting. The goal of this commentary is to address the safety of intravenous thrombolysis with the recombinant tissue plasminogen activator (rTPA) and potential solutions offered by single-photon emission CT (SPECT) as a noninvasive brain perfusion imaging modality. Summary of Review: Even if patients with severe stroke, extensive ischemic changes on CT scan, advanced age, and high blood pressure are excluded from thrombolytic therapy, this cannot completely guarantee the safety of using rTPA. Brain SPECT scanning with hexamethylpropyleneamine oxime (HMPAO) may help to screen out patients at risk if performed in addition to clinical and CT tests. The knowledge of pretreatment severity, extent, and location of ischemia might identify good versus poor responders to rTPA therapy. HMPAO-SPECT is widely available and feasible to perform without delaying rTPA therapy. Rigorous quality control and use of reproducible visual and semiquantitative methods of interpreting SPECT are necessary for implementation of SPECT technology in multicenter clinical trials. Conclusions: The major obstacle to general acceptance of thrombolytic therapies and rTPA in particular is the fear of symptomatic hemorrhagic transformation, and because HMPAO-SPECT might reliably identify patients at high risk of symptomatic hemorrhagic transformation, the clinical value of HMPAO-SPECT in patient selection for thrombolysis during the flint hours of acute ischemic stroke should be determined through a prospective clinical trial.

Original languageEnglish (US)
Pages (from-to)1830-1834
Number of pages5
JournalStroke
Volume28
Issue number9
StatePublished - Sep 1997

Fingerprint

Thrombolytic Therapy
Photons
Neuroimaging
Tissue Plasminogen Activator
Stroke
Safety
Brain
Clinical Trials
Perfusion Imaging
hexamethylpropyleneamine oxime
Quality Control
Patient Selection
Multicenter Studies
Fear
Blood Vessels
Ischemia
Hypertension
Technology
Therapeutics

Keywords

  • Thrombolytic therapy
  • Tissue plasminogen
  • Tomography, emission computed

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Brain single-photon emission CT with HMPAO and safety of thrombolytic therapy in acute ischemic stroke : Proceedings of the meeting of the SPECT Safe Thrombolysis Study Collaborators and the members of the Brain Imaging Council of the Society of Nuclear Medicine. / Alexandrov, Andrei V.; Masdeu, Joseph C.; Devous, Michael D.; Black, Sandra E.; Grotta, James C.

In: Stroke, Vol. 28, No. 9, 09.1997, p. 1830-1834.

Research output: Contribution to journalArticle

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abstract = "Background: To reliably identify patients at risk for symptomatic hemorrhagic transformation (SHT), future trials of thrombolysis for acute ischemic stroke might use a vascular imaging protocol applicable to a multicenter setting. The goal of this commentary is to address the safety of intravenous thrombolysis with the recombinant tissue plasminogen activator (rTPA) and potential solutions offered by single-photon emission CT (SPECT) as a noninvasive brain perfusion imaging modality. Summary of Review: Even if patients with severe stroke, extensive ischemic changes on CT scan, advanced age, and high blood pressure are excluded from thrombolytic therapy, this cannot completely guarantee the safety of using rTPA. Brain SPECT scanning with hexamethylpropyleneamine oxime (HMPAO) may help to screen out patients at risk if performed in addition to clinical and CT tests. The knowledge of pretreatment severity, extent, and location of ischemia might identify good versus poor responders to rTPA therapy. HMPAO-SPECT is widely available and feasible to perform without delaying rTPA therapy. Rigorous quality control and use of reproducible visual and semiquantitative methods of interpreting SPECT are necessary for implementation of SPECT technology in multicenter clinical trials. Conclusions: The major obstacle to general acceptance of thrombolytic therapies and rTPA in particular is the fear of symptomatic hemorrhagic transformation, and because HMPAO-SPECT might reliably identify patients at high risk of symptomatic hemorrhagic transformation, the clinical value of HMPAO-SPECT in patient selection for thrombolysis during the flint hours of acute ischemic stroke should be determined through a prospective clinical trial.",
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