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  Prediction of hemorrhagic transformation after thrombolytic therapy of clot embolism - An MRI investigation in rat brain

Neumann-Haefelin, C., Brinker, G., Uhlenküken, U., Pillekamp, F., Hossmann, K.-A., & Hoehn, M. (2002). Prediction of hemorrhagic transformation after thrombolytic therapy of clot embolism - An MRI investigation in rat brain. Stroke, 33(5), 1392-1398.

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 Creators:
Neumann-Haefelin, C.1, Author              
Brinker, Gerrit1, Author              
Uhlenküken, Ulla2, Author              
Pillekamp, Frank1, Author              
Hossmann, Konstantin-Alexander1, Author              
Hoehn, Mathias2, Author              
Affiliations:
1Konstantin-Alexander Hossmann, Emeriti, Max Planck Institute for Metabolism Research, Managing Director: Jens Brüning, Max Planck Society, ou_2149648              
2In-vivo-NMR, Research Groups, Max Planck Institute for Metabolism Research, Managing Director: Jens Brüning, Max Planck Society, ou_2149666              

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Free keywords: cerebral hemorrhage; contrast media; magnetic resonance imaging; thrombolysis; rats
 Abstract: Copyright 2002 American Heart Association, Inc.
 Abstract: Background and Purpose-Thrombolytic treatment of stroke carries the risk of hemorrhagic transformation. Therefore, the potential of MRI for prediction of recombinant tissue plasminogen activator (rtPA)-induced bleeding is explored to identify patients in whom rtPA treatment may provoke such complications. Methods-Spontaneously hypertensive rats (SHR) (n=9) were submitted to middle cerebral artery (MCA) clot embolism, followed 3 hours later by intra-arterial infusion of 10 mg/kg rtPA. Untreated SHR (n=9) were infused with saline. MRI imaging was performed before treatment and included apparent diffusion coefficient (ADC), T2, and per-fusion mapping and contrast enhancement with gadolinium-DTPA. The distribution of intracerebral hemorrhages was studied 3 days later by histological staining. Results-Clot embolism led to the rapid decline of ADC in the territory of the occluded artery. Tissue lesion volume derived from ADC imaging increased by 155 +/- 69% in the untreated animals and by 168 +/- 87% in the treated animals (P=NS), determined on the histological sections after 3 days. This same lesion growth in both groups indicated absence of therapeutic effect after 3-hour treatment delay. Hemorrhagic transformations were significantly more frequent in treated SHR (P<0.05). In untreated rats, hemorrhages were found in the border zone of the ischemic territory in treated animals, hemorrhagic transformations occurred in the ischemic core region. rtPA-induced hemorrhages were predicted by a disturbance of the blood-brain barrier in 3 of 4 animals before treatment by Gd-DTPA contrast enhancement but not by ADC, T2, or per-fusion imaging. The region of contrast enhancement colocalized with subsequent bleeding in these animals. Conclusions-The disturbance of blood-brain barrier but not of other MR parameters allows risk assessment for hemorrhagic transformation induced by subsequent thrombolytic treatment.

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Language(s): eng - English
 Dates: 2002-05
 Publication Status: Published in print
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Type: Peer
 Identifiers: eDoc: 13391
ISI: 000175447900046
 Degree: -

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Title: Stroke
  Alternative Title : Stroke
Source Genre: Journal
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Pages: - Volume / Issue: 33 (5) Sequence Number: - Start / End Page: 1392 - 1398 Identifier: ISSN: 0039-2499