3.5 Conclusions
MRI is being increasingly used as a selection tool and an outcome measure in stroke trials, reflecting the growing evidence that direct pathophysiologic imaging may provide a more rational approach to acute stroke therapy than clinical diagnosis (and non-contrast CT scanning) alone. Stroke MRI is practical and feasible. Perfusion-diffusion mismatch provides a reliable estimation of the ischaemic penumbra. The future holds great promise. It is only a matter of time before MRI routinely assists the stroke clinician in making individual therapeutic decisions, and guides stroke researchers in identifying effective therapies that can be delivered well beyond the current 3-h window.
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References
Abciximab in Ischemic Stroke Investigators (2000) Abciximab in acute ischemic stroke: a randomized, double-blind, placebo-controlled, dose-escalation study. Stroke 31:601–609
Albers GW, Clark WM (1999) For the ATLANTIS Study Investigators. The ATLANTIS rt-PA (Alteplase) acute stroke trial: final results. Cerebrovasc Dis 9:126
Alexandrov AV, Burgin WS, Demchuk AM, El-Mitwalli A, Grotta JC (2001) Speed of intracranial clot lysis with intravenous tissue plasminogen activator therapy: sonographic classification and short-term improvement. Circulation 103:2897–2902
Astrup J, Symon L, Siesjo BK (1981) Thresholds in cerebral ischemia-the ischemic penumbra. Stroke 12:723–725
Ay H, Buonanno FS, Rordorf G, Schaefer PW, Schwamm LH, Wu O, Gonzalez RG, Yamada K, Sorensen AG, Koroshetz WJ (1999) Normal diffusion-weighted MRI during stroke like deficits. Neurology 52:1784–1792
Baird AE, Benfield A, Schlaug G, Siewert B, Lovblad K, Edelman R, Warach S (1997) Enlargement of human cerebral ischemic lesion volumes measured by diffusion-weighted magnetic resonance imaging. Ann Neurol 41:581–589
Baird AE, Lovblad KO, Dashe JF, Connor A, Burzynski C, Schlaug G, Straroselskaya I, Edelman RR, Warach S (2000) Clinical correlations of diffusion and perfusion lesion volumes in acute ischemic stroke. Cerebrovasc Dis 10:441–448
Baird TA, Parsons MW, Phanh T, Butcher KS, Desmond PM, Tress BM, Colman PG, Chambers BR, Davis SM (2003) Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke 34:2208–2214
Barber PA, Darby DG, Desmond PM, Yang Q, Gerraty RP, Jolley D, Donnan GA, Tress BM, Davis SM (1998a) Prediction of stroke outcome with echoplanar perfusion-and diffusion-weighted magnetic resonance imaging. Neurology 51:418–426
Barber PA, Davis SM, Infeld B, Baird AE, Donnan GA, Jolley D, Lichtenstein M (1998b) Spontaneous reperfusion following ischemic stroke is associated with improved outcome. Stroke 29:2522–2528
Barber PA, Darby DG, Desmond PM, Gerraty RP, Yang Q, Li T, Jolley D, Donnan GA, Tress BM, Davis SM (1999a) Identification of major ischemic change. Diffusion-weighted imaging versus computed tomography. Stroke 30:2059–2065
Barber PA, Darby DG, Desmond PM, Yang Q, Gerraty RP, Jolley D, Donnan GA, Tress BM, Davis SM (1999b) Absent middle cerebral artery flow predicts the presence and evolution of the ischemic penumbra. Neurology 52:1125–1132
Barber PA, Parsons MW, Desmond PM, Bennet DA, Donnan GA, Tress BM, Davis SM (2004) The use of PWI and DWI measures in the design of “proof of concept” stroke trials. J Neuroimaging 14:123–132
Baron JC, von Kummer R, del Zoppo GJ (1995) Treatment of acute ischemic stroke: challenging the concept of a rigid and universal time window. Stroke 26:2219–2221
Beaulieu C, de Crespigny A, Tong DC, Moseley ME, Albers GW, Marks MP (1999) Longitudinal magnetic resonance imaging study of perfusion and diffusion in stroke: evolution of lesion volume and correlation with clinical outcome (see comments). Ann Neurol 46:568–578
Brandt T, Grau AJ, Hacke W (1996) Severe stroke. Baillieres Clin Neurol 5:515–541
Brott TG, Haley EC Jr, Levy DE, Barsan W, Broderick J, Sheppard GL, Spilker J, Kongable GL, Massey S, Reed R et al (1992) Urgent therapy for stroke. Part I. Pilot study of tissue plasminogen activator administered within 90 minutes. Stroke 23:632–640
Butcher K, Parsons M, Baird T, Barber A, Donnan G, Desmond P, Tress B, Davis S (2003) Perfusion thresholds in acute stroke thrombolysis. Stroke 34:2159–2164
Calamante F, Thomas DL, Pell GS, Wiersma J, Turner R (1999) Measuring cerebral blood flow using magnetic resonance imaging techniques. J Cereb Blood Flow Metab 19:701–735
Calamante F, Gadian DG, Connelly A (2002) Quantification of perfusion using bolus tracking magnetic resonance imaging in stroke: assumptions, limitations, and potential implications for clinical use. Stroke 33:1146–1151
Caplan LR, Mohr JP, Kistler JP, Koroshetz W (1997) Should thrombolytic therapy be the first-line treatment for acute ischemic stroke? Thrombolysis-not a panacea for ischemic stroke. N Engl J Med 337:1309–1310; discussion 1313
Chalela JA, Ezzeddine M, Latour L, Warach S (2003) Reversal of perfusion and diffusion abnormalities after intravenous thrombolysis for a lacunar infarction. J Neuroimaging 13:152–154
Chalela JA, Kang DW, Luby M, Ezzeddine M, Latour LL, Todd JW, Dunn B, Warach S (2004) Early magnetic resonance imaging findings in patients receiving tissue plasminogen activator predict outcome: insights into the pathophysiology of acute stroke in the thrombolysis era. Ann Neurol 55:105–112
Darby DG, Barber PA, Gerraty RP, Desmond PM, Yang Q, Parsons M, Li T, Tress BM, Davis SM (1999) Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke 30:2043–2052
Davis SM, Donnan GA (2002) Neuroprotection: establishing proof of concept in human stroke. Stroke 33:309–310
Davis SM, Donnan GA (2004) Advances in penumbra imaging with MR. Cerebrovasc Dis 17[Suppl 3]:23–27
Desmond PM, Lovell AC, Rawlinson AA, Parsons MW, Barber PA, Yang Q, Li T, Darby DG, Gerraty RP, Davis SM, Tress BM (2001) The value of apparent diffusion coefficient maps in early cerebral ischemia. AJNR Am J Neuroradiol 22:1260–1267
Donnan GA, Howells DW, Markus R, Toni D, Davis SM (2003) Can the time window for administration of thrombolytics in stroke be increased? CNS Drugs 17:995–1011
Ernst R, Pancioli A, Tomsick T, Kissela B, Woo D, Kanter D, Jauch E, Carrozzella J, Spilker J, Broderick J (2000) Combined intravenous and intra-arterial recombinant tissue plasminogen activator in acute ischemic stroke. Stroke 31:2552–2557
Fiebach JB, Schellinger PD, Gass A, Kucinski T, Siebler M, Villringer A, Olkers P, Hirsch JG, Heiland S, Wilde P, Jansen O, Rother J, Hacke W, Sartor K (2004) Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke 35:502–506
Fink JN, Kumar S, Horkan C, Linfante I, Selim MH, Caplan LR, Schlaug G (2002) The stroke patient who woke up: clinical and radiological features, including diffusion and perfusion MRI. Stroke 33:988–993
Fisher M (1997) Characterizing the target of acute stroke therapy. Stroke 28:866–872
Fisher M, Brott TG (2003) Emerging therapies for acute ischemic stroke: new therapies on trial. Stroke 34:359–361
Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 282:2003–2011
Ginsberg MD, Pulsinelli WA (1994) The ischemic penumbra, injury thresholds, and the therapeutic window for acute stroke. Ann Neurol 36:553–554
Grandin CB, Duprez TP, Smith AM, Oppenheim C, Peeters A, Robert AR, Cosnard G (2002) Which MR-derived perfusion parameters are the best predictors of infarct growth in hyperacute stroke? Comparative study between relative and quantitative measurements. Radiology 223:361–370
Grond M, Rudolf J, Schmulling S, Stenzel C, Neveling M, Heiss WD (1998) Early intravenous thrombolysis with recombinant tissue-type plasminogen activator in vertebrobasilar ischemic stroke. Arch Neurol 55:466–469
Hacke W (2004) Desmoteplase In Acute Stroke Study (DIAS)-results of phase II trial. International Stroke Conference, San Diego
Hacke W, Warach S (2000) Diffusion-weighted MRI as an evolving standard of care in acute stroke. Neurology 54:1548–1549
Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ (1988) Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19:1216–1222
Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Hoxter G, Mahagne MH, Henerici M (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 274:1017–1025
Hacke W, Kaste M, Fieschi C (1998) Randomised double-blind placebo controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 352:1245–1251
Haley EC Jr, Levy DE, Brott TG, Sheppard GL, Wong MC, Kongable GL, Torner JC, Marler JR (1992) Urgent therapy for stroke. Part II. Pilot study of tissue plasminogen activator administered 91—180 minutes from onset. Stroke 23:641–645
Heiss WD (1983) Flow thresholds for functional and morphological damage of brain tissue. Stroke 14:329–331
Hossman K-A (1994) Viability thresholds and the penumbra of focal ischemia. Ann Neurol 36:557–565
Hossmann K-A, Sakaki S, Zimmermann V (1977) Cation activities in reversible ischemia of the cat brain. Stroke 8:77–81
Jansen O, Schellinger P, Fiebach J, Hacke W, Sartor K (1999) Early recanalisation in acute ischaemic stroke saves tissue at risk defined by MRI. Lancet 353:2036–2037
Jovin TG, Yonas H, Gebel JM, Kanal E, Chang YF, Grahovac SZ, Goldstein S, Wechsler LR (2003) The cortical ischemic core and not the consistently present penumbra is a determinant of clinical outcome in acute middle cerebral artery occlusion. Stroke 34:2426–2433
Kidwell CS, Saver JL, Mattiello J, Starkman S, Vinuela F, Duckwiler G, Gobin YP, Jahan R, Vespa P, Kalafut M, Alger JR (2000) Thrombolytic reversal of acute human cerebral ischemic injury shown by diffusion/perfusion magnetic resonance imaging. Ann Neurol 47:462–469
Kidwell CS, Saver JL, Villablanca JP, Duckwiler G, Fredieu A, Gough K, Leary MC, Starkman S, Gobin YP, Jahan R, Vespa P, Liebeskind DS, Alger JR, Vinuela F (2002) Magnetic resonance imaging detection of microbleeds before thrombolysis: an emerging application. Stroke 33:95–98
Kidwell CS, Alger JR, Saver JL (2003) Beyond mismatch: evolving paradigms in imaging the ischemic penumbra with multimodal magnetic resonance imaging. Stroke 34:2729–2735
Lees KR, Asplund K, Carolei A, Davis SM, Diener HC, Kaste M, Orgogozo JM, Whitehead J (2000) Glycine antagonist (gavestinel) in neuroprotection (GAIN International) in patients with acute stroke: a randomised controlled trial. GAIN International Investigators. Lancet 355:1949–1954
Li F, Han SS, Tatlisumak T, Liu K-F, Garcia JH, Sotak C, Fisher M (1999) Reversal of acute apparent diffusion coefficient abnormalities and delayed neuronal death following transient focal cerebral ischemia in rats. Ann Neurol 46:333–342
Li F, Silva MD, Liu KF, Helmer KG, Omae T, Fenstermacher JD, Sotak CH, Fisher M (2000) Secondary decline in apparent diffusion coefficient and neurological outcomes after a short period of focal brain ischemia in rats. Ann Neurol 48:236–244
Lin DD, Filippi CG, Steever AB, Zimmerman RD (2001) Detection of intracranial hemorrhage: comparison between gradient-echo images and b(0) images obtained from diffusion-weighted echo-planar sequences. AJNR Am J Neuroradiol 22:1275–1281
Linfante I, Llinas RH, Caplan LR, Warach S (1999) MRI features of intracerebral hemorrhage within 2 hours from symptom onset. Stroke 30:2263–2267
Linfante I, Llinas RH, Selim M, Chaves C, Kumar S, Parker RA, Caplan LR, Schlaug G (2002) Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator. Stroke 33:2066–2071
Lovblad K, Baird AE, Schlaug G, Benfield A, Siewert B, Voetsch B, Connor A, Burzynski C, Edelman R, Warach S (1997) Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome. Ann Neurol 42:164–170
Lovblad KO, Laubach HJ, Baird AE, Curtin F, Schlaug G, Edelman RR, Warach S (1998) Clinical experience with diffusion-weighted MR in patients with acute stroke. AJNR Am J Neuroradiol 19:1061–1066
Marks MP, Tong DC, Beaulieu C, Albers GW, de Crespigny A, Moseley ME (1999) Evaluation of early reperfusion and i.v. tPA therapy using diffusion-and perfusion-weighted MRI (see comments). Neurology 52:1792–1798
Markus R, Reutens DC, Kazui S, Read S, Wright P, Chambers BR, Sachinidis JI, Tochon-Danguy HJ, Donnan GA (2003) Topography and temporal evolution of hypoxic viable tissue identified by 18F-fluoromisonidazole positron emission tomography in humans after ischemic stroke. Stroke 34:2646–2652
Marler JR, Tilley BC, Lu M, Brott TG, Lyden PC, Grotta JC, Broderick JP, Levine SR, Frankel MP, Horowitz SH, Haley EC Jr, Lewandowski CA, Kwiatkowski TP (2000) Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 55:1649–1655
Muir KW, Lees KR (1995) A randomized, double-blind, placebo-controlled pilot trial of intravenous magnesium sulfate in acute stroke. Ann NY Acad Sci 765:315–316
Muller TB, Haraldseth O, Jones RA, Sebastiani G, Godtliebsen F, Lindboe CF, Unsgard G (1995) Combined perfusion and diffusion-weighted magnetic resonance imaging in a rat model of reversible middle cerebral artery occlusion. Stroke 26:451–457; discussion 457-458
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587
Neumann-Haefelin T, Wittsack HJ, Wenserski F, Siebler M, Seitz RJ, Modder U, Freund HJ (1999) Diffusion-and perfusion-weighted MRI. The DWI/PWI mismatch region in acute stroke. Stroke 30:1591–1597
Neumann-Haefelin T, du Mesnil de Rochemont R, Fiebach JB, Gass A, Nolte C, Kucinski T, Rother J, Siebler M, Singer OC, Szabo K, Villringer A, Schellinger PD (2004) Effect of incomplete (spontaneous and postthrombolytic) recanalization after middle cerebral artery occlusion: a magnetic resonance imaging study. Stroke 35:109–114
Nighoghossian N, Hermier M, Adeleine P, Blanc-Lasserre K, Derex L, Honnorat J, Philippeau F, Dugor JF, Froment JC, Trouillas P (2002) Old microbleeds are a potential risk factor for cerebral bleeding after ischemic stroke: a gradient-echo T2*-weighted brain MRI study. Stroke 33:735–742
Oppenheim C, Logak M, Dormont D, Lehericy S, Manai R, Samson Y, Marsault C, Rancurel G (2000) Diagnosis of acute ischaemic stroke with fluid-attenuated inversion recovery and diffusion-weighted sequences. Neuroradiology 42:602–607
Ostrem JL, Saver JL, Alger JR, Starkman S, Leary MC, Duckwiler G, Jahan R, Vespa P, Villablanca JP, Gobin YP, Vinuela F, Kidwell CS (2004) Acute basilar artery occlusion: diffusion-perfusion MRI characterization of tissue salvage in patients receiving intra-arterial stroke therapies. Stroke 35:e30–e34
Parsons MW, Yang Q, Barber PA, Darby DG, Desmond PM, Gerraty RP, Tress BM, Davis SM (2001) Perfusion magnetic resonance imaging maps in hyperacute stroke: relative cerebral blood flow most accurately identifies tissue destined to infarct. Stroke 32:1581–1587
Parsons MW, Barber PA, Chalk J, Darby DG, Rose S, Desmond PM, Gerraty RP, Tress BM, Wright PM, Donnan GA, Davis SM (2002a) Diffusion-and perfusion-weighted MRI response to thrombolysis in stroke. Ann Neurol 51:28–37
Parsons MW, Barber PA, Desmond PM, Baird TA, Darby DG, Byrnes G, Tress BM, Davis SM (2002b) Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol 52:20–28
Patel SC, Levine SR, Tilley BC, Grotta JC, Lu M, Frankel M, Haley EC, Jr., Brott TG, Broderick JP, Horowitz S, Lyden PD, Lewandowski CA, Marler JR, Welch KM (2001) Lack of clinical significance of early ischemic changes on computed tomography in acute stroke. JAMA 286:2830–2838
Perl J 2nd, Tkach JA, Porras-Jimenez M, Lieber M, Obuchowski N, Ross JS, Ding XP, Ruggieri PM, Shearer DM, Khajavi K, Masaryk TJ (1999) Hemorrhage detected using MR imaging in the setting of acute stroke: an in vivo model. AJNR Am J Neuroradiol 20:1863–1870
Powers WJ (2000) Testing a test. A report card for DWI in acute stroke. Neurology 54:1549–1551
Powers WJ, Zivin JA (1998) Magnetic resonance imaging in acute stroke. Not ready for prime time. Neurology 50:842–843
Prosser J, Butcher K, Allport L, Parsons MW, Baird TA, MacGregor L, Tress BM, Davis SM (2004) Clinical-diffusion mismatch predicts the penumbra with high specificity. World stroke congress, Vancouver
Read SJ, Hirano T, Abbott DF, Markus R, Sachinidis JI, Tochon-Danguy HJ, Chan JG, Egan GF, Scott AM, Bladin CF, McKay WJ, Donnan GA (2000) The fate of hypoxic tissue on 18F-fluoromisonidazole positron emission tomography after ischemic stroke. Ann Neurol 48:228–235
Saunders DE, Howe FA, van den Boogaart A, McLean MA, Griffiths JR, Brown MM (1995) Continuing ischemic damage after acute middle cerebral artery infarction in humans demonstrated by short-echo proton spectroscopy. Stroke 26:1007–1013
Schellinger PD, Jansen O, Fiebach JB, Heiland S, Steiner T, Schwab S, Pohlers O, Ryssel H, Sartor K, Hacke W (2000) Monitoring intravenous recombinant tissue plasminogen activator thrombolysis for acute ischemic stroke with diffusion and perfusion MRI. Stroke 31:1318–1328
Schellinger PD, Fiebach JB, Jansen O, Ringleb PA, Mohr A, Steiner T, Heiland S, Schwab S, Pohlers O, Ryssel H, Orakcioglu B, Sartor K, Hacke W (2001) Stroke magnetic resonance imaging within 6 hours after onset of hyperacute cerebral ischemia. Ann Neurol 49:460–469
Schellinger PD, Fiebach JB, Hacke W (2003) Imaging-based decision making in thrombolytic therapy for ischemic stroke: present status. Stroke 34:575–583
Schlaug G, Benfield A, Baird AE, Siewert B, Lovblad KO, Parker RA, Edelman RR, Warach S (1999) The ischemic penumbra: operationally defined by diffusion and perfusion MRI. Neurology 53:1528–1537
Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, Hacke W (1998) Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 29:1888–1893
Schwab S, Georgiadis D, Berrouschot J, Schellinger PD, Graffagnino C, Mayer SA (2001) Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 32:2033–2035
Selim M, Fink JN, Kumar S, Caplan LR, Horkan C, Chen Y, Linfante I, Schlaug G (2002) Predictors of hemorrhagic transformation after intravenous recombinant tissue plasminogen activator: prognostic value of the initial apparent diffusion coefficient and diffusion-weighted lesion volume. Stroke 33:2047–2052
Sorensen AG, Copen WA, Ostergaard L, Buonanno FS, Gonzalez RG, Rordorf G, Rosen BR, Schwamm LH, Weisskoff RM, Koroshetz WJ (1999) Hyperacute stroke: simultaneous measurement of relative cerebral blood volume, relative cerebral blood flow, and mean tissue transit time. Radiology 210:519–527
Sunshine JL, Tarr RW, Lanzieri CF, Landis DM, Selman WR, Lewin JS (1999) Hyperacute stroke: ultrafast MR imaging to triage patients prior to therapy. Radiology 212:325–332
Sunshine JL, Bambakidis N, Tarr RW, Lanzieri CF, Zaidat OO, Suarez JI, Landis DM, Selman WR (2001) Benefits of perfusion MR imaging relative to diffusion MR imaging in the diagnosis and treatment of hyperacute stroke. AJNR Am J Neuroradiol 22:915–921
Thijs VN, Adami A, Neumann-Haefelin T, Moseley ME, Marks MP, Albers GW (2001) Relationship between severity of MR perfusion deficit and DWI lesion evolution. Neurology 57:1205–1211
Thomalla GJ, Kucinski T, Schoder V, Fiehler J, Knab R, Zeumer H, Weiller C, Rother J (2003) Prediction of malignant middle cerebral artery infarction by early perfusion-and diffusion-weighted magnetic resonance imaging. Stroke 34:1892–1899
Tong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Moseley ME (1998) Correlation of perfusion-and diffusion-weighted MRI with NIHSS score in acute (<6.5 hour) ischemic stroke (see comments). Neurology 50:864–870
Tong DC, Adami A, Moseley ME, Marks MP (2001) Prediction of hemorrhagic transformation following acute stroke: role of diffusion-and perfusion-weighted magnetic resonance imaging. Arch Neurol 58:587–593
Von Kummer R, Allen KL, Holle R, Bozzao L, Bastianello S, Manelfe C, Bluhmki E, Ringleb P, Meier D, Hacke W (1997) Acute stroke: usefulness of early CT findings before thrombolytic therapy. Radiology 205:327–333
Warach S (2001) Tissue viability thresholds in acute stroke: the 4-factor model. Stroke 32:2460–2461
Warach S, Gaa J, Siewert B, Wielopolski P, Edelman R (1995) Acute human stroke studied by whole brain echoplanar diffusion-weighted magnetic resonance imaging. Ann Neurol 37:231–141
Warach S, Dashe JF, Edelman RR (1996) Clinical outcome in ischemic stroke predicted by early diffusion-weighted and perfusion magnetic resonance imaging: a preliminary analysis. J Cereb Blood Flow Metab 16:53–59
Warach S, Pettigrew LC, Dashe JF, Pullicino P, Sabounjian L (1999) The effect of citicholine on lesion volume in acute stroke: a multicenter double blind placebo controlled trial. Stroke 30:243
Wardlaw JM (2001) Overview of Cochrane thrombolysis metaanalysis. Neurology 57:S69–S76
Yamaguchi T, Sano K, Takakura K, Saito I, Shinohara Y, Asano T, Yasuhara H (1998) Ebselen in acute ischemic stroke: a placebo-controlled, double-blind clinical trial. Ebselen Study Group. Stroke 29:12–17
Yenari MA, de Crespigny A, Palmer JT, Roberts S, Schrier SL, Albers GW, Moseley ME, Steinberg GK (1997) Improved perfusion with rt-PA and hirulog in a rabbit model of embolic stroke. J Cereb Blood Flow Metab 17:401–411
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Parsons, M.W., Davis, S.M. (2006). Therapeutic Impact of MRI in Acute Stroke. In: von Kummer, R., Back, T. (eds) Magnetic Resonance Imaging in Ischemic Stroke. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27738-2_3
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