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Time window and "tissue window": two approaches to assist decision-making in strokes
1Department of Neurology, Union Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue in Hankou, Wuhan, 430022, China.
Journal of Neurology
|June 21, 2018
Summary
The "tissue window" approach, using brain imaging to assess tissue viability, can identify more ischemic stroke patients eligible for alteplase treatment beyond the standard time window. This imaging-based method complements traditional time restrictions for reperfusion therapy.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- Intravenous alteplase is guideline-recommended for ischemic stroke within a specific time window.
- Treatment efficacy of alteplase decreases over time.
- Patient selection is often limited by hospital arrival time, potentially excluding eligible individuals.
Purpose of the Study:
- To explore the concept of a
- tissue window
- as a complementary criterion for ischemic stroke treatment.
- To affirm the value of the
- tissue window
- when traditional time windows are not met.
- To investigate how advanced neuroimaging can define the penumbra and extend therapeutic options.
Main Methods:
- Review of current treatment guidelines and time-window limitations.
- Detailed definition and explanation of the
- tissue window
- concept.
- Comparison of various neuroimaging techniques for penumbra determination.
- Analysis of favorable imaging patterns for patient selection.
Main Results:
- The
- tissue window
- concept allows for patient recruitment based on tissue viability, not solely time.
- Neuroimaging techniques can effectively identify the ischemic penumbra.
- Certain imaging patterns indicate eligibility for intervention beyond standard time limits.
Conclusions:
- The
- tissue window
- approach offers a more reliable method for patient selection in ischemic stroke.
- It can extend the therapeutic time window for alteplase in select patients with good collateral circulation.
- Integrating imaging criteria enhances treatment eligibility and outcomes.
