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MRI-guided therapy in acute stroke
1National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA. Peter_Schellinger@med.uni-heidelberg.de
Insights
Acute stroke thrombolysis can be effective beyond 3 hours. This review proposes a new diagnostic approach using advanced MRI to personalize treatment, improving outcomes for stroke patients.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Stroke is a leading cause of death and disability globally.
- Thrombolysis is the standard acute stroke treatment within 3 hours.
- Evidence suggests potential benefits between 3-6 hours, but patient selection is key.
Purpose of the Study:
- To review the current status of thrombolytic therapy for acute stroke.
- To propose an individualized patient management strategy beyond rigid time windows.
- To develop a treatment algorithm based on multiparametric MRI findings.
Main Methods:
- Review of existing literature on thrombolysis in acute stroke.
- Development of a diagnostic approach integrating pathophysiological reasoning.
- Utilizing a multiparametric stroke magnetic resonance imaging (MRI) protocol.
Main Results:
- Meta-analyses indicate thrombolysis may be effective 3-6 hours post-stroke.
- Improved patient selection criteria are needed for optimal thrombolytic therapy.
- Multiparametric MRI can provide pathophysiological information for treatment decisions.
Conclusions:
- Individualized stroke management based on pathophysiology is superior to rigid time windows.
- Advanced MRI protocols can guide personalized thrombolytic therapy decisions.
- This approach aims to maximize treatment benefits and minimize risks in acute stroke patients.
Abstract:
Stroke is the third leading cause of death after myocardial infarction and cancer and the leading cause of permanent disability and of disability-adjusted loss of independent life-years in Western countries. Thrombolysis is the treatment of choice for acute stroke within 3 h after onset of symptoms. Treatment beyond the 3-h time window has not been shown to be effective in any single trial, however, meta-analyses suggest a somewhat less but still significant effect within 3 to 6 h after stroke. It seems reasonable to apply improved selection criteria that allow the differentiation of patients with a relevant indication for thrombolytic therapy from those who have not. An overview of a diagnostic approach to acute stroke management that allows patient management individualization based on pathophysiological reasoning and not rigid time windows, established by randomized controlled trials is presented. Therefore, this review concentrates in the first part on giving the reader an integrated knowledge of the current status of thrombolytic therapy in stroke, and in the second part, develops a treatment algorithm based on pathophysiological information rendered by a multiparametric stroke magnetic resonance imaging protocol.
