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Fig. 2F —Pretreatment and early posttreatment imaging in 64-year-old
man with 2 hours of aphasia and right hemiparesis who underwent IV recombinant
tissue plasminogen activator therapy within 3-hour time window recommended for
IV therapy. Posttreatment axial maximum-intensity-projection image (E)
from CT angiogram performed 24 hours after therapy now shows patency of left
middle cerebral artery, consistent with complete recanalization. Posttreatment
perfusion CT image now shows diminished cerebral blood volume (F),
diminished cerebral blood flow (G), and prolonged MTT (H) in
anterior temporal lobe, consistent with infarction, as well as previously
noted hemodynamic alteration consistent with infarction in posterior temporal
lobe. This figure shows that mere fact of recanalization does not guarantee
salvage of tissue and may interfere with testing of prediction paradigm if not
adequately documented. For instance, anterior temporal lobe may have
progressed to infarction between time of imaging and time of therapy.
Alternatively, as result of recanalization, distal emboli from initial
thrombus may have propagated into arterial supply of anterior temporal lobe,
causing infarction.
