Early Findings of Computed Tomography and Angiography in Acute Stroke and Thrombolytic Therapy

Before thrombolytic treatment in acute stroke, a computed tomographic (CT) scan is necessary to exclude brain hemorrhage and other causes of focal neurological deficit imitating cerebral ischemia. Angiographic demonstration of arterial occlusion is a precondition for local intraarterial infusion of thrombolytics. At present, several major clinical trials testing the effect of intravenous thrombolytic treatment in acute stroke are conducted without the information of initial angiography so as to gain time for early treatment [1–3]. So far, there are only a few reports available concerning the significance of CT scan and angiography for thrombolytic treatment [4–7]. We studied the question whether positive signs of cerebral ischemia in CT scan such as parenchymal hypodensity and focal brain swelling, together with the angiographically proved site of arterial occlusion and state of collateral blood supply, have predictive value for arterial recanalization and clinical outcome in hemispheric stroke. The significance of angiography in basilar artery occlusion is reported elsewhere in these proceedings (See Chapter, “Thrombolytic Therapy of Basilar Artery Occlusion: Preconditions for Recanalization and Good Clinical Outcome,” in this volume). Data of subgroups of patients reported here have been published previously [8–10].