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Related Experiment Videos

Imaging in cerebrovascular disease.

W D Heiss1, M Forsting, H C Diener

  • 1Max-Planck Institute for Neurological Research and Department of Neurology, University of Cologne, Cologne, Germany. h.diener@uni-essen.de

Current Opinion in Neurology
|February 15, 2001
PubMed
Summary

Functional imaging identifies penumbra in acute ischemic stroke, guiding thrombolytic therapy. Advanced techniques like intra-arterial thrombolysis and angioplasty offer new treatment options beyond traditional windows.

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Acute ischemic stroke involves functionally impaired tissue (penumbra) distinct from irreversibly damaged areas.
  • Identifying the penumbra is crucial for effective treatment selection and outcome prediction.

Purpose of the Study:

  • To review functional imaging modalities for identifying penumbra in acute ischemic stroke.
  • To discuss the role of these modalities in patient selection for thrombolytic therapy and as surrogate markers.
  • To highlight advancements in interventional neuroradiology for stroke treatment.

Main Methods:

  • Positron emission tomography (PET)
  • Perfusion and diffusion-weighted magnetic resonance imaging (MRI)
  • Single-photon computed tomography (SPECT)

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  • Xenon computed tomography (CT)

    • Main Results:

    • Comparable flow thresholds for irreversible tissue damage and penumbra were established across modalities (5-12 ml/100 g/min lower, 14-22 ml/100 g/min upper limit).
    • Functional imaging aids in selecting patients for thrombolytic therapy and evaluating treatment effects.
    • Intra-arterial thrombolysis is now a viable option beyond the 3-hour window for acute ischemic stroke.

    Conclusions:

    • Functional imaging is vital for characterizing tissue viability in acute ischemic stroke.
    • Interventional neuroradiology, including angioplasty and stenting, shows promise for extended therapeutic windows.
    • Randomized trials are needed to compare endovascular treatments with vascular surgery for cerebrovascular stenosis.