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Imaging selection for acute stroke intervention.

Bruce Cv Campbell1, Mark W Parsons1,2

  • 11 Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia.

International Journal of Stroke : Official Journal of the International Stroke Society
|March 16, 2018
PubMed
Summary
This summary is machine-generated.

Brain imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), is crucial for guiding stroke treatment. Advanced imaging techniques help select patients for reperfusion therapies and inform prognosis, improving stroke care.

Keywords:
CT angiographyCT perfusionIschemic strokecomputed tomographyendovascular thrombectomyintra-arterial clot retrievalmagnetic resonance imagingthrombolysis

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Brain imaging is essential for diagnosing stroke, identifying its cause, and informing acute treatment, prognosis, and secondary prevention strategies.
  • Computed tomography (CT) and magnetic resonance imaging (MRI) are the primary imaging modalities used in stroke management.
  • Mobile stroke units are extending the reach of prehospital CT imaging.

Purpose of the Study:

  • To review the current applications of brain imaging in guiding stroke treatment.
  • To highlight the role of imaging in patient selection for reperfusion therapies.
  • To discuss the potential of imaging in future stroke interventions.

Main Methods:

  • Review of current knowledge on brain imaging in stroke treatment.
  • Analysis of the impact of imaging on acute treatment decisions, particularly reperfusion.
  • Consideration of imaging's role in prognosis and selection for novel therapies.

Main Results:

  • Imaging selection based on ischemic core volume is critical for reperfusion decisions in patients presenting beyond 6 hours of stroke onset, as established by the DAWN and DEFUSE 3 trials.
  • Estimated ischemic core volume, combined with patient factors and time to reperfusion, is a key prognostic indicator for patients within 6 hours of onset.
  • Imaging may identify candidates for emerging neuroprotective agents, edema reduction therapies, and interventions preventing hemorrhagic transformation.

Conclusions:

  • Brain imaging is indispensable for modern stroke management, from diagnosis to guiding advanced reperfusion therapies.
  • Imaging-based patient selection is evolving, particularly for extended time windows and novel therapeutic approaches.
  • Future stroke treatment will likely rely heavily on sophisticated imaging to personalize interventions and improve outcomes.