Are There Time-Dependent Differences in Diffusion and Perfusion Within the First 6 Hours After Stroke Onset?

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Abstract
Background and Purpose— Stroke heterogeneity in computed tomography-based studies has been attributed as main cause for missing efficacy of intravenous tissue plasminogen activator (tPA) therapy within 3 to 6 hours. We investigated early time-dependent differences in acute stroke pathophysiology by multiparametric magnetic resonance imaging (MRI). Methods— Stroke MRI of 112 acute ischemic stroke patients within −9 mm/s 2 (ADC 8 seconds. A subsample analysis was performed for occlusions of the middle carotid artery (MCA) trunk (n=36) and MCA branches (n=30), and for all patients treated by intravenous tPA (n=70). Results— ADC and TTP lesion volumes were not different within 2 seconds, and infarct volume (days 5 to 8) between the 2 groups. There was a greater proportion of ADC P =0.05) after correction for multiple testing. Conclusions— We observed no significant time-dependent differences within 6 hours after stroke onset in degree and volume of diffusion and perfusion impairment. An exclusion from intravenous tPA solely based on a rigid 3-hour time window seems unjustified in MRI-confirmed ischemic stroke.