Imaging in acute stroke
Prasanna Eswaradass1, Ramana Appireddy1, James Evans1
1a Calgary Stroke Program, Department of Clinical Neurosciences , University of Calgary , Calgary , AB , Canada.
Insights
Advanced imaging techniques like CT scans are crucial for quickly identifying stroke patients eligible for treatments such as endovascular therapy (EVT). This improves decision-making in hyperacute stroke care.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Stroke is a leading cause of death and disability in Canada.
- Hyperacute stroke management requires time-critical treatment decisions.
- Advances in medical imaging aid in selecting patients for acute stroke interventions.
Purpose of the Study:
- To review the role of CT imaging in acute stroke assessment.
- To discuss Non-Contrast Computed Tomography (NCCT), CT-Angiography (CTA), and CT-Perfusion (CTP) in evaluating ischemic stroke and intracerebral hemorrhage.
- To highlight the importance of imaging in patient selection for reperfusion therapies.
Main Methods:
- Review of current literature on CT imaging modalities for stroke.
- Discussion of the application of NCCT, CTA, and CTP in hyperacute stroke.
- Analysis of imaging's role in recent clinical trials for endovascular therapy (EVT).
Main Results:
- Intravenous thrombolysis (tPA) was the standard for acute ischemic stroke within 4.5 hours.
- Five recent trials demonstrated the efficacy of EVT for acute ischemic stroke with proximal arterial occlusion.
- Imaging was pivotal for patient selection in all five major EVT trials.
Conclusions:
- CT imaging (NCCT, CTA, CTP) is essential for diagnosing and managing acute ischemic stroke and intracerebral hemorrhage.
- EVT has emerged as a key treatment for specific acute ischemic stroke patients, with imaging guiding selection.
- Continued advancements in imaging technology will further enhance rapid clinical assessment and timely stroke treatment.
Introduction:
Stroke is the third leading cause of death and disability in Canada. In the hyperacute stroke setting, the treating physician must make a time critical decision on the treatment of each patient. Recent advances in imaging help the treating physician identify the subgroup of patients eligible for acute treatment of ischaemic stroke.
Areas Covered:
In this review we will discuss Non-Contrast Computed Tomography (NCCT), CT-Angiography (CTA), and CT-Perfusion (CTP) in assessment of patients with acute ischaemic stroke and intracerebral haemorrhage. Intravenous tPA was the only proven therapy for acute ischaemic stroke presenting within 4.5 hours, until the five recent trials proved the efficacy of EVT for acute ischaemic stroke with proximal arterial occlusion. Imaging played a major role in patient selection in all five trials. Expert commentary: The challenge of rapid clinical assessment, review of imaging and timely treatment will continue to be made easier as the development and understanding of imaging progresses.
Related Concept Videos
01:14Brain Imaging
These technologies include computerized axial tomography (CAT or CT scans), positron-emission tomography (PET scans), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and Transcranial Magnetic...
01:21Imaging Studies for Cardiovascular System IV: CMRI