Related Experiment Video
Updated: Jul 14, 2026
13:10
Combined Near-infrared Fluorescent Imaging and Micro-computed Tomography for Directly Visualizing Cerebral Thromboemboli
Published on: September 25, 2016
Acute stroke imaging for thrombolytic therapy--an update.
Martin Köhrmann1, Eric Jüttler, Hagen B Huttner
1Department of Neurology, University Hospital of Erlangen, Erlangen, Germany.
Cerebrovascular Diseases (Basel, Switzerland)
|June 29, 2007
Summary
Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is the sole approved acute ischemic stroke therapy. This review explores advanced imaging techniques for patient selection beyond the standard 3-hour window, optimizing treatment decisions.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Intravenous thrombolysis using recombinant tissue plasminogen activator (rtPA) remains the only FDA-approved treatment for acute ischemic stroke.
- Current treatment guidelines primarily focus on patients within a 3-hour time window post-symptom onset.
- There is a need for improved patient selection strategies to expand treatment eligibility.
Purpose of the Study:
- To provide an updated overview of advanced imaging techniques for acute ischemic stroke.
- To discuss the role of CT angiography (CTA), perfusion CT (CTP), and MRI in patient selection for thrombolysis.
- To propose an institutional algorithm for selecting patients for thrombolysis within and beyond the 3-hour window.
Main Methods:
- Comprehensive review of recent publications on diagnostic accuracy of advanced imaging modalities.
- Analysis of data from new randomized trials and large prospective studies.
- Development of a pathophysiologically-based institutional algorithm for thrombolysis selection.
Main Results:
- Advanced CT techniques like CTA and CTP offer valuable insights into ischemic stroke pathophysiology.
- Stroke MRI provides complementary information for patient selection, potentially extending the therapeutic window.
- Evidence supports the use of imaging to identify suitable candidates for thrombolysis beyond 3 hours.
Conclusions:
- Modern imaging techniques significantly enhance the ability to select appropriate patients for thrombolysis.
- An evidence-based algorithm can guide the judicious use of thrombolysis in acute ischemic stroke, including extended time windows.
- Optimizing patient selection through advanced imaging is crucial for improving outcomes in acute ischemic stroke management.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
01:29Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...