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Abstract
Objective: Fast magnetic resonance imaging (MRI) and susceptibility-weighted imaging (SWI) methods may provide more accurate detection of the highly variant time window for successful intravenous (IV) thrombolytic drug treatment (averaging 3 hours) for cerebral microbleeds (CMBs) in acute stroke patients.
Methods: This prospective study applies fast MRI and SWI for examination of 279 prescreened ischemic stroke patients within 12 hours of stroke onset. One hundred and sixty-two (58·1%) of 279 patients were diagnosed with super-acute ischemic stroke with restricted diffusion, hyperintense diffusion-weighted imaging signals, and no ischemic change in T2-weighted imaging, fluid-attenuated inversion recovery, or T1-weighted imaging signals. Recombinant tissue plasminogen activator IV thrombolysis was administered to 113 (69·75%) patients (thrombolysis group). All patients underwent regular sequence MRI and SWI follow-up.
Results: Computed tomography and MRI sequence scans revealed hemorrhagic transformations in 13 (11·50%) thrombolysis and four (8·16%) non-thrombolysis group patients. MRI-guided thrombolysis treatment produced no significant differences between the two groups. SWI revealed new CMBs in 46 (40·70%) and nine (18·37%) thrombolysis and non-thrombolysis group patients, respectively. Significantly better National Institutes of Health stroke scale (24 hours) (P<0·05), modified Rankin scale (90 days) (P<0·01), and life quality Barthal index scores were observed in CMB patients (P<0·01).
Conclusions: SWI revealed higher CMB incidence and clinical improvement in recombinant tissue plasminogen activator IV thrombolysis-treated super-acute ischemic stroke patients, suggesting that CMBs may indicate vascular re-canalization/reperfusion. Thus, SWI can be applied to extend individual patient windows for thrombolytic treatment beyond general recommendations of treatment within 3 hours, allowing treatment up to 12 hours from stroke onset.
We are thankful for the support and funding provided by the Key Discipline Construction Project of the Pudong Health Bureau of Shanghai (grant no. PWZXK2010-03), Outstanding Leader Training Program of the Pudong Health Bureau of Shanghai (grant no. PWR12010-02), Research Grant for Health Science and Technology of the Pudong Health Bureau of Shanghai (grant no. PKJ2010-Y28, PW2009A-12), and the National Eleven-Fifth Scientific and Technological Brainstorm project (grant nos. 2006BA101A11 and 2007BA105B07).
