Imaging-based treatment selection for intravenous and intra-arterial stroke therapies: a comprehensive review
- 1 July 2011
- journal article
- review article
- Published by Taylor & Francis Ltd in Expert Review of Cardiovascular Therapy
- Vol. 9 (7), 857-876
- https://doi.org/10.1586/erc.11.56
Abstract
Reperfusion therapy is the only approved treatment for acute ischemic stroke. The current approach to patient selection is primarily based on the time from stroke symptom onset. However, this algorithm sharply restricts the eligible patient population, and neglects large variations in collateral circulation that ultimately determine the therapeutic time window in individual patients. Time alone is unlikely to remain the dominant parameter. Alternative approaches to patient selection involve advanced neuroimaging methods including MRI diffusion-weighted imaging, magnetic resonance and computed tomography perfusion imaging and noninvasive angiography that provide potentially valuable information regarding the state of the brain parenchyma and the neurovasculature. These techniques have now been used extensively, and there is emerging evidence on how specific imaging data may result in improved clinical outcomes. This article will review the major studies that have investigated the role of imaging in patient selection for both intravenous and intra-arterial therapies.Keywords
This publication has 137 references indexed in Scilit:
- Pretreatment Diffusion- and Perfusion-MR Lesion Volumes Have a Crucial Influence on Clinical Response to Stroke ThrombolysisJournal of Cerebral Blood Flow & Metabolism, 2010
- MR Mismatch Profiles in Patients with Intracranial Atherosclerotic Stroke: A Comprehensive approach Comparing Stroke SubtypesJournal of Cerebral Blood Flow & Metabolism, 2009
- Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion–diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled studyThe Lancet Neurology, 2009
- Impact of collateral flow on tissue fate in acute ischaemic strokeJournal of Neurology, Neurosurgery & Psychiatry, 2007
- Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparisonThe Lancet, 2007
- Magnetic resonance perfusion diffusion mismatch and thrombolysis in acute ischaemic stroke: a systematic review of the evidence to dateJournal of Neurology, Neurosurgery & Psychiatry, 2006
- Symptomatic intracranial haemorrhage after intra-arterial thrombolysis in acute ischaemic stroke: assessment of 294 patients treated with urokinaseJournal of Neurology, Neurosurgery & Psychiatry, 2006
- Perfusion-CT Assessment of Infarct Core and PenumbraStroke, 2006
- Importance of Early Ischemic Computed Tomography Changes Using ASPECTS in NINDS rtPA Stroke StudyStroke, 2005
- High resolution measurement of cerebral blood flow using intravascular tracer bolus passages. Part I: Mathematical approach and statistical analysisMagnetic Resonance in Medicine, 1996