Evolution of lesion volume in acute stroke treated by intravenous t‐PA

Abstract

Purpose:To determine the evolution of the ischemic lesion volumes in a population treated with tissue plasminogen activator (t-PA), MRIs were performed before treatment and 24 hours later; final infarct size was evaluated 60 days later. Materials and Methods:A total of 42 patients with hemispheric stroke were recruited for a thrombolytic study. Intravenous t-PA was given after MRI within the first seven hours after stroke onset. Volumes were evaluated on day 0 and day 1 with diffusion-weighted imaging (DWI), on day 60 with T2-weighted imaging (T2WI), and recanalization was assessed based on day 1 MR angiography (MRA).Results: Lesion volume increased between day 0 and day 1, and decreased between day 1 and day 60. It was lower in the group of patients with recanalization on day 1 MRA. Conclusion:Volume analysis emphasizes the effectiveness of recanalization as a predictive factor for better outcome, based on final infarct size. The decrease in lesion volumes between day 1 and day 60 suggests that other factors leads to overestimation of day 1 abnormal diffusion volume. This could explain the delayed partial reversibility of the DWI abnormality.

Lesion Volume Change After Treatment With Tissue Plasminogen Activator Can Discriminate Clinical Responders From Nonresponders

“…8 Volume changes with tPA treatment have been studied by others. 2,4,15,16 Not all investigators, however, found volume decrease after tPA treatment. For example, Röther et al found that median 7-day T2 volumes were larger than the baseline DWI (35 mL versus 22 mL) among 76 patients treated with intravenous tPA within 6 hours of onset of symptoms.…”

Brain Stem Diffusion-Weighted Imaging Lesion Score: A Potential Marker of Outcome in Acute Basilar Artery Occlusion

“…Treatment strategies show great variations in different hospitals regarding the method (intra-arterial versus intravenous procedures) and time window for eligibility. Al- though recanalization may favor partial reversibility of the DWI anomaly, 24 the baseline brain stem DWI score may help to identify patients most likely to benefit from treatment. Extensive brain stem damage may indicate poor prognosis regardless of recanalization success or failure (Fig 3).…”

Speed of tPA-Induced Clot Lysis Predicts DWI Lesion Evolution in Acute Stroke

“…Median baseline DWI and PWI lesion volumes were 42 cm 3 (interquartile range, 3 to 108 cm 3 ) and 188 cm 3 (interquartile range 60 to 252 cm 3 ), respectively. The mean change in DWI lesions on follow-up MRI was 38.46Ϯ50.4 cm 3 .…”

“…1,2 The extent of DWI lesion enlargement has been correlated with final infarct size and long-term clinical outcome. [3][4][5][6] Therefore, DWI lesion growth has been proposed as a surrogate outcome measure in neuroprotective and thrombolytic trials. 7,8 This idea is supported by the demonstration that DWI abnormality growth may be attenuated or even reversed, partially or completely, after early therapeutically driven recanalization.…”