The Imaging-Neuropathological Gap in Acute Large Vessel Occlusive Stroke

Area of Science:

• Neurology
• Radiology
• Pathology

Background:

• Endovascular thrombectomy is a key treatment for large ischemic strokes.
• Historically, advanced imaging guided patient selection for thrombectomy.
• Recent trials indicate consistent benefits across all imaging groups.

Purpose of the Study:

• To review histopathologic studies and clinical trials on imaging in stroke.
• To assess the accuracy of current imaging modalities in defining ischemic tissue.
• To highlight the gap between imaging and neuropathology in stroke treatment.

Main Methods:

• Literature review of histopathologic studies.
• Analysis of recent endovascular thrombectomy clinical trials.
• Synthesis of imaging findings and neuropathological outcomes.

Main Results:

• Large ischemic stroke patients benefit from thrombectomy irrespective of imaging strata.
• Current imaging may not accurately differentiate reversible from irreversible ischemic tissue.
• A significant gap exists between imaging interpretations and actual neuropathological states.

Conclusions:

• The utility of current imaging for selecting patients for endovascular thrombectomy is questionable.
• Reperfusion benefit may extend beyond what is predicted by existing imaging techniques.
• Further research is needed to bridge the imaging-neuropathological gap in stroke management.