+ Site Statistics
References:
52,654,530
Abstracts:
29,560,856
PMIDs:
28,072,755
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn

+ Translate
+ Recently Requested

Application of acute stroke imaging: selecting patients for revascularization therapy



Application of acute stroke imaging: selecting patients for revascularization therapy



Neurology 79(13 Suppl 1): S86-S94



Due to the dynamic and versatile characteristics of ischemic penumbra, selecting the right acute ischemic stroke (AIS) patients for revascularization therapy (RT) based on initial available imaging can be challenging. The main patient selection criterion for RT is the size of the mismatch between the potentially salvageable tissue (penumbra) and the irreversibly damaged tissue (core). The goal of revascularization RT is to "freeze" the core and prevent it from extending to the penumbral tissue. Penumbral imaging selection of AIS patients for RT, using magnetic resonance or CT-based studies, may provide more clinical benefit to the appropriate patients, although direct evidence is pending. Not all penumbra-core mismatches beyond 3 hours are equal and need treatment, and defining which mismatches to target for RT is the current goal of ongoing clinical trials. In addition to "penumbral"-based imaging, large vessel occlusion and clot length estimation based on CT angiography and noncontrasted ultrathin CT scan has been used to identify patients who are refractory to systemic thrombolysis and may be eligible for endovascular therapy. The application of various imaging modalities in selecting and triaging AIS patients for RT is discussed in this review. Larger prospective randomized trials are needed to better understand the role of various imaging modalities in selecting AIS patients for RT and to understand its influence on clinical outcome.

(PDF emailed within 0-6 h: $19.90)

Accession: 051607893

Download citation: RISBibTeXText

PMID: 23008419

DOI: 10.1212/WNL.0b013e3182695800



Related references

MRI-based selection for intra-arterial stroke therapy: value of pretreatment diffusion-weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization. Stroke 40(6): 2046-2054, 2009

Perfusion CT for selecting patients with acute ischemic stroke for intravenous thrombolytic therapy. Radiology 274(1): 103-114, 2015

The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy. Neuroradiology 54(7): 663-672, 2012

Prediction of recanalization in acute stroke patients receiving intravenous and endovascular revascularization therapy. International Journal of Stroke 10(1): 28-36, 2015

Education for stroke neurologists in neuroendovascular revascularization therapy of acute ischemic stroke. Rinsho Shinkeigaku 54(12): 1207-1210, 2015

Imaging-based selection for revascularization in acute ischemic stroke. Current Opinion in Neurology 29(1): 20-29, 2016

Cerebral blood flow thresholds for tissue infarction in patients with acute ischemic stroke treated with intra-arterial revascularization therapy depend on timing of reperfusion. Ajnr. American Journal of Neuroradiology 32(5): 846-851, 2011

International survey of acute stroke imaging used to make revascularization treatment decisions. International Journal of Stroke 10(5): 759-762, 2016

Endovascular Recanalization in Acute Ischemic Stroke Using the Solitaire FR Revascularization Device with Adjunctive C-Arm CT Imaging. Ajnr. American Journal of Neuroradiology 36(7): 1317-1320, 2016

Revascularization grading in endovascular acute ischemic stroke therapy. Neurology 79(13 Suppl 1): S110-S116, 2012

Number needed to screen for acute revascularization trials in stroke: Prognostic and predictive imaging biomarkers. International Journal of Stroke, 2016

Optimal workflow and process-based performance measures for endovascular therapy in acute ischemic stroke: analysis of the Solitaire FR thrombectomy for acute revascularization study. Stroke 45(7): 2024-2029, 2014

The predictive value of the Boston Acute Stroke Imaging Scale (BASIS) in acute ischemic stroke patients among Chinese population. Plos One 9(12): E113967-E113967, 2015

Why the Medical Malpractice Crisis Persists Even When Malpractice Insurance Premiums Fall. Health Matrix 25: 163-226, 2015

Early ischemic change on CT versus diffusion-weighted imaging for patients with stroke receiving intravenous recombinant tissue-type plasminogen activator therapy: stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry. Stroke 42(8): 2196-2200, 2012