J Neurosonol Neuroimag.
2023 Jun;15(1):1-23. 10.31728/jnn.2023.00134.
Advanced Imaging in the Current Era of Acute Reperfusion Therapies
- Psychogios K
1,2 - Kargiotis O2
- Safouris A1,2
- Magoufis G3,4
- Palaiodimou L1
- Papadopoulou M1,5
- Spiliopoulos S4
- Velonakis G6
- Mantatzis M7
- Karapanayiotides T8
- Mitsias P9
- Tsivgoulis G1,10
- Affiliations
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- 1Second Department of Neurology, National & Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece
- 2Stroke Unit, Metropolitan Hospital, Piraeus, Greece
- 3Neuroradiology Department, Metropolitan Hospital, Piraeus, Greece
- 4Second Department of Radiology, Interventional Radiology Unit, “Attikon” University Hospital, National & Kapodistrian University of Athens, Athens, Greece
- 5Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Athens, Greece
- 6Second Department of Radiology, “Attikon” University Hospital, National & Kapodistrian University of Athens, Athens, Greece
- 7Department of Radiology, Interventional Neuroradiology Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- 8Second Department of Neurology, School of Medicine, Faculty of Health Sciences, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- 9Department of Neurology Medical School, University of Crete, Heraklion, Crete, Greece
- 10Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
- KMID: 2543836
- DOI: http://doi.org/10.31728/jnn.2023.00134
Abstract
- Reperfusion of the ischemic brain parenchyma with intravenous thrombolysis and/or mechanical thrombectomy is the cornerstone of acute ischemic stroke treatment. A paradigm shift from “time is brain” to a more precision medicine approach now called “imaging is brain”, has taken place during the last decade. This transformation has been fueled by the progress in neuroimaging. Advanced Neuroimaging incorporates perfusion imaging in order to depict real-time cerebral perfusion disturbances and provide maps of the penumbra and ischemic core that will inform individualized clinical decisions. Advance neuroimaging has now a fundamental role in triaging patients that will receive reperfusion treatments beyond the conventional time windows of 4.5 hours for intravenous thrombolysis and 6 hours for mechanical thrombectomy. We provide a narrative review of all the pivotal observational studies and randomized-controlled clinical trials that supported the use of advance neuroimaging, as well as technical issues and pitfalls that may be useful for its implementation in routine clinical practice.
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