@article{oai:niigata-u.repo.nii.ac.jp:00020270,
 author = {小泉, 孝幸},
 issue = {3},
 journal = {新潟医学会雑誌, 新潟医学会雑誌},
 month = {Mar},
 note = {Although intra-arterial local infusion of fibrinolytic agents is performed in recent years, the efficacy of the treatment is controversial even now. Therefore, the present study has been carried out in an attempt to clarify which patients with cerebral embolism benefit from this therapy, with special references as to the intracranial hemodynamics. The intracranial hemodynamics were evaluated by single photon emission computed tomography (SPECT) in 43 patients after the intra-arterial local fibrinolytic therapy and in 9 of them just before the treatment. SPECT was made using ^<99m>Tc-d, 1-hexamethyl-propylene-amine oxime (HM-PAO) or N-isopropyl p-[＾<123>I]-iodoamphetamine (^<123>I-IMP). Relative quantification by means of region-of-interest (ROI) analysis was performed, and the 2 parameters of R/Ce (regional cerebellar ratio) and AI (asymmetry index) were calculated in each patient just before the treatment. Qualitative analysis was also performed after the treatment. The present study has revealed that the images of SPECT taken within 24 hours after the treatment are divided into three patterns: normal perfusion pattern, hypoperfusion pattern, and hyperperfusion pattern. The patients showing the normal perfusion pattern after complete recanalization develop no or a smaller infarction on CT scans. However, the patients with the hypoperfusion or hyperperfusion pattern develop a large infarction. The present study also showed that the regions with R/Ce below 0.3 and/or the AI above 1.5 are irreversible and develop cerebral infarction regardless of the duration of ischemia. On the other hand, the regions with R/Ce more than 0.5 or AI less than 1.2 are reversible and develop no infarction. That is, the intra-arterial local fibrinolytic therapy seems to be useful especially for the patients with slight reduction of rCBF (R/Ce＞0.5, AI＜1.2), whereas it is likely to be useless for the patients with marked reduction of rCBF (R/Ce＜0.3, AI＞1.5). If begun more promptly, it also appears to be useful for the patients with moderate reduction of rCBF (0.3＜R/Ce＜0.5, 1.5＞AI＞1.2). On the basis of the present study, the author has assumed that reversibility of ischemic regions could be determined by use of SPECT, and prediction of the reversibility would lead to a better management of the patients with acute cerebral embolism.},
 pages = {272--283},
 title = {超急性期血行再開通前後の脳循環動態 : その経時的変化と超急性期血行再開通の意義},
 volume = {107},
 year = {1993}
}