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Advanced Imaging in the Era of Tissue-Based Treatment for Acute Ischemic Stroke—a Practical Review

  • Cerebrovascular Disorders (D Jamieson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of the review

Advanced imaging is now used to identify acute ischemic stroke (AIS) patients for treatment with tissue plasminogen activator or mechanical thrombectomy, who are either out of the traditional treatment window or have an unknown last known well time. Current guidelines recommend adapting the complex inclusion criteria used in the clinical trials to provide optimal individual patient decisions in clinical practice. This review aims to facilitate such integration by organizing the available data in a practical clinical context.

Recent findings

We review two clinical vignettes of advanced imaging for the treatment of AIS, the rationale for using the imaging criteria with correlations from the gold-standard quantitative oxygen-15 positron emission tomography imaging to understand cerebral ischemia and magnetic resonance imaging, and its limitations.

Summary

Advanced stroke imaging is required to treat patients with AIS in the extended time window. Understanding the rationale, differences in the individual study criteria and limitations of imaging can help the treating physician in incorporating advanced stroke imaging-based clinical trials in clinical practice.

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Author information

Authors and Affiliations

  1. Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA

    Nandakumar Nagaraja MD, MS

  2. Department of Neurology, Georgetown University School of Medicine, Washington, DC, USA

    Jośe G. Merino MD

  3. Departments of Neurology, Neurosurgery and Epidemiology, Carver College of Medicine and College of Public Health, University of Iowa, Iowa City, IA, USA

    Enrique C. Leira MD, MS

  4. Department of Neurology, Dell Medical School, University of Texas At Austin, Austin, TX, USA

    Steven Warach MD, PhD

Authors
  1. Nandakumar Nagaraja MD, MS
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  2. Jośe G. Merino MD
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  3. Enrique C. Leira MD, MS
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  4. Steven Warach MD, PhD
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Corresponding author

Correspondence to Nandakumar Nagaraja MD, MS .

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Conflict of interest

Nandakumar Nagaraja is a stroke outcome adjudicator for the Women’s Health Initiative study and receives small per-case stipend for this role and receives research/salary support from the NIH and McJunkin Foundation Alzheimer’s Disease Fund through 1Florida Alzheimer’s Disease Research Center. José G Merino receives salary support from the American Academy of Neurology for his role as Editor-in-Chief of Neurology. Enrique Leira receives salary support from NIH-NINDS. Steven Warach is a consultant for Genentech and chair of the independent data monitoring committee for the TIMELESS trial.

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This article is part of the Topical Collection on Cerebrovascular Disorders

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Nagaraja, N., Merino, J.G., Leira, E.C. et al. Advanced Imaging in the Era of Tissue-Based Treatment for Acute Ischemic Stroke—a Practical Review. Curr Treat Options Neurol 23, 32 (2021). https://doi.org/10.1007/s11940-021-00685-1

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