Imaging in Acute Anterior Circulation Ischemic Stroke: Current and Future

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Revascularization treatments like thrombolysis and thrombectomy are effective for acute ischemic stroke within specific time windows.
• Many patients are ineligible for these treatments, and some treatments carry risks.
• Current guidelines emphasize imaging for selecting eligible patients for acute stroke reperfusion therapy.

Purpose of the Study:

• To review imaging methods and criteria for selecting patients eligible for revascularization in acute anterior circulation stroke.
• To focus on the 2019 American Heart Association/American Stroke Association guidelines for patient selection.
• To discuss future directions in imaging-based selection to enhance treatment efficacy.

Main Methods:

• Review of clinical trials and guidelines on acute ischemic stroke revascularization.
• Analysis of the role of neuroimaging in patient selection for reperfusion therapies.
• Focus on imaging criteria for anterior circulation stroke based on 2019 guidelines.

Main Results:

• Imaging plays a crucial role in excluding hemorrhage and stroke mimics.
• Neuroimaging assesses salvageable brain tissue, localizes occlusions, estimates collateral circulation, and predicts hemorrhagic transformation.
• Specific imaging criteria are vital for selecting patients for intravenous thrombolysis and endovascular thrombectomy.

Conclusions:

• Imaging is indispensable for optimizing patient selection for acute ischemic stroke revascularization.
• Adherence to imaging criteria in guidelines improves the safety and effectiveness of stroke treatments.
• Future advancements in imaging will further refine patient selection and treatment outcomes.