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From the Department of Neurology (Drs. Yasaka, Chambers, Baird, Hirano, and Donnan and H. O'Malley) and the Department of Nuclear Medicine and Center for Positron Emission Tomography (Dr. O'Keefe), Austin & Repatriation Medical Centre; and the Department of Neurology (Drs. Davis and Infeld), Royal Melbourne Hospital, Victoria, Australia.
Address correspondence and reprint requests to Dr. Geoffrey A. Donnan, Department of Neurology, Austin & Repatriation Medical Centre, Austin Campus, Melbourne, Victoria 3084, Australia.
The Australian Streptokinase Trial was a randomized, double-blind, placebo-controlled trial, in which streptokinase (SK, 1.5 million IU IV) was given within 4 hours of stroke onset. In a subset of 37 patients,99m Tc-labeled D,L-hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT) and/or transcranial Doppler (TCD) studies were performed before and after therapy to test the hypothesis that SK may improve the hemodynamic measures of reperfusion/recanalization rates(TCD parameter) within 24 hours. Eighteen patients received SK and 19 placebo. Baseline characteristics were similar in both groups, and there were no differences in clinical outcomes assessed at 3 months after stroke. Although there was no increase in the group mean perfusion defect or volume on SPECT after thrombolytic therapy, a larger number of patients demonstrating the combined end point of reperfusion or recanalization was seen in the SK group (13/14, 93%) than in the placebo group (7/14, 50%;p = 0.01). Although SK given within 4 hours of acute ischemic stroke appears to improve arterial patency/tissue reperfusion, this effect is neither early nor extensive enough to influence overall clinical outcome.
Supported by the National Stroke Foundation and National Health and Medical Research Council of Australia.
Received February 5, 1997. Accepted in final form November 18, 1997.
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