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Departments of Neurology (Drs. Ringelstein, Biniek, Weiller, Ammeling, and Nolte) and Neuroradiology (Dr. Thron), University Hospital RWTH, Aachen, Germany.
We evaluated the influence of time of recanalization or degree of initial leptomeningeal collateral blood flow in cardioembolic or arterio-arterial middle cerebral artery (MCA) occlusion on infarct size and clinical outcome in a series of 34 consecutive acute stroke patients with main stem (N = 31) or major branch (N = 3) occlusions using CT, initial cerebral arteriography (N = 21), repetitive close-meshed transcranial Doppler ultrasonography, and a neurologic stroke scale. We treated 15 patients with tissue plasminogen activator intravenously within the first 6 hours. The type and size of infarction depended on the location of the occluding lesions within the MCA trunk. Proximal MCA occlusion always led to infarction involving the striatum and internal capsule. Sixty-five percent of patients showed recanalization of the occluded MCA within 1 week. Following MCA recanalization, hyperperfusion was present in 38 to 44% of cases. There was a marginally significant relation between size of infarction on CT and recanalization time within the first 24 hours. The more rapidly recanalization occurred, the smaller the size of the infarct. When recanalization time was greater than 8 hours, the lesions always extended to the cortex. An additional good leptomeningeal collateral blood flow significantly reduced the size of the infarct and improved clinical outcome after 17 days and after 10 months. Early recanalization of embolic MCA occlusions within up to 8 hours, in conjunction with good transcortical collateralization, has a favorable impact on infarct size and outcome and may constitute the therapeutic window of opportunity.
Address correspondence and reprint requests to Dr. Erich Bernd Ringelstein, Associate Professor of Neurology, Department of Neurology, Klinikum RWTH, University Hospital, D-5100 Aachen, Germany.
Received January 18, 1991. Accepted for publication in final form July 26, 1991.
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A. R. Young, O. Touzani, J.-M. Derlon, G. Sette, E. T. MacKenzie, and J.-C. Baron Early Reperfusion in the Anesthetized Baboon Reduces Brain Damage Following Middle Cerebral Artery Occlusion : A Quantitative Analysis of Infarction Volume Stroke, March 1, 1997; 28(3): 632 - 638. [Abstract] [Full Text]
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D. Toni, M. Fiorelli, S. Bastianello, A. Falcou, G. Sette, V. Ceschin, M. L. Sacchetti, and C. Argentino Acute Ischemic Strokes Improving During the First 48 Hours of Onset: Predictability, Outcome, and Possible Mechanisms: A Comparison With Early Deteriorating Strokes Stroke, January 1, 1997; 28(1): 10 - 14. [Abstract] [Full Text]
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M. D. Ginsberg The Validity of Rodent Brain-Ischemia Models Is Self-evident Arch Neurol, October 1, 1996; 53(10): 1065 - 1067. [Abstract] [PDF]
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L. Belayev, O. F. Alonso, R. Busto, W. Zhao, M. D. Ginsberg, and C. Y. Hsu Middle Cerebral Artery Occlusion in the Rat by Intraluminal Suture: Neurological and Pathological Evaluation of an Improved Model Stroke, September 1, 1996; 27(9): 1616 - 1623. [Abstract] [Full Text]
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T. Brandt, R. von Kummer, M. Muller-Kuppers, and W. Hacke Thrombolytic Therapy of Acute Basilar Artery Occlusion : Variables Affecting Recanalization and Outcome Stroke, May 1, 1996; 27(5): 875 - 881. [Abstract] [Full Text]
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W. Hacke, S. Schwab, M. Horn, M. Spranger, M. De Georgia, and R. von Kummer 'Malignant' Middle Cerebral Artery Territory Infarction: Clinical Course and Prognostic Signs Arch Neurol, April 1, 1996; 53(4): 309 - 315. [Abstract] [PDF]
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N. Heye Microthromboemboli in Acute Infarcts : Analysis of 40 Autopsy Cases Stroke, March 1, 1996; 27(3): 431 - 434. [Abstract] [Full Text]
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J. Bogousslavsky, A. Bernasconi, and E. Kumral Acute Multiple Infarction Involving the Anterior Circulation Arch Neurol, January 1, 1996; 53(1): 50 - 57. [Abstract] [PDF]
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J.C. Baron, R. von Kummer, and G.J. del Zoppo Treatment of Acute Ischemic Stroke : Challenging the Concept of a Rigid and Universal Time Window Stroke, December 1, 1995; 26(12): 2219 - 2221. [Full Text]
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A. Davalos, J. Castillo, and E. Martinez-Vila Delay in Neurological Attention and Stroke Outcome Stroke, December 1, 1995; 26(12): 2233 - 2237. [Abstract] [Full Text]
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R. U. Kothari, T. Brott, J. P. Broderick, and C. A. Hamilton Emergency Physicians : Accuracy in the Diagnosis of Stroke Stroke, December 1, 1995; 26(12): 2238 - 2241. [Abstract] [Full Text]
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G. Seidel, M. Kaps, and T. Gerriets Potential and Limitations of Transcranial Color-Coded Sonography in Stroke Patients Stroke, November 1, 1995; 26(11): 2061 - 2066. [Abstract] [Full Text]
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W. Hacke, M. Kaste, C. Fieschi, D. Toni, E. Lesaffre, R. von Kummer, G. Boysen, E. Bluhmki, G. Hoxter, M.-H. Mahagne, et al. Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator for Acute Hemispheric Stroke: The European Cooperative Acute Stroke Study (ECASS) JAMA, October 4, 1995; 274(13): 1017 - 1025. [Abstract] [PDF]
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 M. D. Ginsberg Review : Neuroprotection in Brain Ischemia: An Update (Part II Neuroscientist, May 1, 1995; 1(3): 164 - 175. [Abstract] [PDF]
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R. von Kummer, R. Holle, L. Rosin, M. Forsting, and W. Hacke Does Arterial Recanalization Improve Outcome in Carotid Territory Stroke? Stroke, April 1, 1995; 26(4): 581 - 587. [Abstract] [Full Text]
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E. M. Zanette, C. Roberti, G. Mancini, C. Pozzilli, M. Bragoni, and D. Toni Spontaneous Middle Cerebral Artery Reperfusion in Ischemic Stroke : A Follow-up Study With Transcranial Doppler Stroke, March 1, 1995; 26(3): 430 - 433. [Abstract] [Full Text]
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H. S. Jorgensen, B. Sperling, H. Nakayama, H. O. Raaschou, and T. S. Olsen Spontaneous Reperfusion of Cerebral Infarcts in Patients With Acute Stroke: Incidence, Time Course, and Clinical Outcome in the Copenhagen Stroke Study Arch Neurol, September 1, 1994; 51(9): 865 - 873. [Abstract] [PDF]
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M. Fisher and J. Bogousslavsky Evolving Toward Effective Therapy for Acute Ischemic Stroke JAMA, July 21, 1993; 270(3): 360 - 364. [Abstract] [PDF]
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