Imaging-based selection for endovascular treatment in stroke

Kambiz Nael, Yu Sakai, Pooja Khatri, Charles J. Prestigiacomo, Josep Puig, Achala Vagal

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Treatment of acute ischemic stroke (AIS) has evolved significantly in the past few years. Endovascular treatment (EVT) is now proved to be efficacious up to 24 hours from onset in properly selected patients. The recently updated 2018 American Heart Association– American Stroke Association guidelines reflect the important role of imaging in triage and patient selection for EVT of AIS. Pretreatment imaging in patients with acute stroke should (a) allow assessment for intracranial hemorrhage and demonstrate (b) the extent of early ischemic changes, (c) the presence of large arterial occlusion, and (d) in some cases potential salvageable tissue before the decision to proceed with EVT. The authors review how multimodality imaging can be used for EVT selection in the context of the recent guidelines. They highlight the importance of having streamlined imaging workflows that are integrated with clinical decision making to maximize treatment efficiency. Knowledge of the various imaging criteria including perfusion imaging used for EVT selection is highlighted. The authors discuss variable imaging paradigms used for selection of patients in the early and late windows (who present before vs after 6 hours from onset of symptoms), as reflected in the latest guidelines and in relation to their level of evidence. Finally, they focus on challenges in the subgroups of patients who were excluded from recent EVT trials and with limited evidence to prove the efficacy of EVT, such as patients with low NIHSS (National Institutes of Health Stroke Scale) score, distal occlusion, or large ischemic core.

Original languageEnglish (US)
Pages (from-to)1696-1713
Number of pages18
JournalRadiographics
Volume39
Issue number6
DOIs
StatePublished - Oct 2019
Externally publishedYes

Fingerprint

Patient Selection
Stroke
Guidelines
Therapeutics
Perfusion Imaging
Workflow
Intracranial Hemorrhages
Triage
National Institutes of Health (U.S.)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Nael, K., Sakai, Y., Khatri, P., Prestigiacomo, C. J., Puig, J., & Vagal, A. (2019). Imaging-based selection for endovascular treatment in stroke. Radiographics, 39(6), 1696-1713. https://doi.org/10.1148/rg.2019190030

Imaging-based selection for endovascular treatment in stroke. / Nael, Kambiz; Sakai, Yu; Khatri, Pooja; Prestigiacomo, Charles J.; Puig, Josep; Vagal, Achala.

In: Radiographics, Vol. 39, No. 6, 10.2019, p. 1696-1713.

Research output: Contribution to journalArticle

Nael, K, Sakai, Y, Khatri, P, Prestigiacomo, CJ, Puig, J & Vagal, A 2019, 'Imaging-based selection for endovascular treatment in stroke', Radiographics, vol. 39, no. 6, pp. 1696-1713. https://doi.org/10.1148/rg.2019190030
Nael K, Sakai Y, Khatri P, Prestigiacomo CJ, Puig J, Vagal A. Imaging-based selection for endovascular treatment in stroke. Radiographics. 2019 Oct;39(6):1696-1713. https://doi.org/10.1148/rg.2019190030
Nael, Kambiz ; Sakai, Yu ; Khatri, Pooja ; Prestigiacomo, Charles J. ; Puig, Josep ; Vagal, Achala. / Imaging-based selection for endovascular treatment in stroke. In: Radiographics. 2019 ; Vol. 39, No. 6. pp. 1696-1713.
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