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Imaging Acute Ischemic Stroke: Mapping Present and Future Clinical Practice

  • Cardiovascular Disease and Stroke (S Prabhakaran, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Imaging is an increasingly key component of advances in stroke care. Its role in the success of multiple recently reported trials that have now driven new standards of practice highlights its expanding importance in acute stroke management. With significant gains already realized, routine practice only stands to benefit further from additional advances in imaging in the future. The degree to which imaging will impact stroke care, however, is uncertain and complex: multiple aspects of stroke research and its translation into updated practice contribute to it. In this article, a few of these critical issues and questions related to imaging and its potential, both present and future, to drive stroke care forward are addressed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20. Recent successful randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS.

    Article  PubMed  Google Scholar 

  2. Bracard, S., Guillemin F., Ducrocq X. et al. for the THRACE investigators.. THRACE study: intermediate analysis results. Presented at the European Stroke Organization Conference; April 18, 2015; Glasgow. Recent successful randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS .

  3. Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18. Recent successful randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS.

    Article  CAS  PubMed  Google Scholar 

  4. Goyal M, Demchuk AM, Menon BK, for the ESCAPE Trial Investigators, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30. Recent successful randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS.

    Article  CAS  PubMed  Google Scholar 

  5. Saver J, Goyal M, Bonafe A, et al. For the SWIFT PRIME Investigators. Int J Stroke. 2015;10(3):439–48. Recent successful randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Jovin T, Chamorro A, Cobo E, et al. for the REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. Epub 2015 Apr 17. Recent successful randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS

  7. Mocco J, Zaidat O, von Kummer R, et al. Results of the THERAPY trial: A prospective randomized trial to define the role of mechanical thrombectomy as adjuntive treatment to IV r-TPA in acute ischemic stroke. Presented at the European Stroke Organization Conference; April 17, 2015; Glasgow. Recent randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS.

  8. Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS study group. Alberta stroke programme early CT score. Lancet. 2000;355(9216):1670–4.

    Article  CAS  PubMed  Google Scholar 

  9. Lansberg MG, Straka M, Kemp S, for the DEFUSE 2 study investigators, et al. MRI profile and response to endovascular reperfusion after stroke (DEFUSE 2): a prospective cohort study. Lancet Neurol. 2012;11(10):860–7.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Kidwell CS, Jahan R, Gornbein J, for the MR RESCUE Investigators, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013;368(10):914–23. Recent randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Schwamm, L., Warach, S. Wu, O. and Latour, L. MR WITNESS: A study of intravenous thrombolysis with alteplase in MRI-selected patients. In: Clinicaltrials.gov [online]. Available at: clinicaltrials.gov/ct2/show/NCT01282242 (2015) Accessed 5/17/2015.

  12. Jovin T, Noguiera R. Trevo and Medical Management Versus Medical Management Alone in Wake Up and Late Presenting Strokes (DAWN). In: Clinicaltrials.gov [online]. Available at: clinicaltrials.gov/ct2/show/NCT02142283. Accessed 5/17/2015.

  13. Broderick JP, Palesch YY, Demchuk AM, for the Interventional Management of Stroke (IMS) III Investigators, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013;368(10):893–903. Recent randomized controlled endovascular trials utilizing advanced imaging for selective treatment of AIS.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Tansy AP, Liebeskind D. The goldilocks dilemma in acute ischemic stroke. Front Neurol. 2013;4:164.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Ford AL, Williams JA, Spencer M, et al. Reducing door-to-needle times using Toyota’s lean manufacturing principles and value stream analysis. Stroke. 2012;43(12):3395–8.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Meretoja A, Strbian D, Mustanoja S, et al. Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology. 2012;79(4):306–13.

    Article  PubMed  Google Scholar 

  17. Lo EH, Moskowitz MA, Jacobs TP. Exciting, radical, suicidal: how brain cells die after stroke. Stroke. 2005;36(2):189–92.

    Article  PubMed  Google Scholar 

  18. Spokoyny I, Raman R, Ernstrom K, et al. Pooled assessment of computed tomography interpretation by vascular neurologists in the STRokE DOC telestroke network. J Stroke Cerebrovasc Dis. 2014;23(3):511–5.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Demaerschalk BM, Bobrow BJ, Raman R, et al. For the stroke team remote evaluation using a digital observation camera (STRokE DOC) in Arizona—the initial Mayo Clinic experience (AZ TIME) investigators. CT interpretation in a telestroke network: agreement among a spoke radiologist, hub vascular neurologist, and hub neuroradiologist. Stroke. 2012;43(11):3095–7.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Coutts SB, Modi J, Patel SK, et al. What causes disability after transient ischemic attack and minor stroke? Results from the CT and MRI in the triage of TIA and minor cerebrovascular events to identify high risk patients (CATCH) study. Stroke. 2012;43(11):3018–22.

    Article  PubMed  Google Scholar 

  21. Genentech, Inc. Potential of rtPA for Ischemic Strokes with Mild Symptoms (PRISMS). In: Clinicaltrials.gov [online]. Available at: clinicaltrials.gov/ct2/show/NCT02072226. Accessed: 5/17/2015.

  22. American Heart Association. Get With The Guidelines-Stroke. In: Get With the Guidelines-Stroke [online]. Available at: www.heart.org/HEARTORG/HealthcareResearch/GetWithTheGuidelines/GetWithTheGuidelines-Stroke/Get-With-The-Guidelines-Stroke-Overview_UCM_308021_Article.jsp. Accessed: 5/17/2015.

  23. Interventional Stroke Therapy Outcomes Registry. In: INSTOR [online]. Available at: www.strokeregistry.org. Accessed: 5/17/2015.

  24. Nogueira RG, Lutsep HL, Gupta R, et al. For the TREVO 2 Trialists. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380(9849):1231–40.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke (STRATIS) Registry. In: Clinicaltrials.gov [online]. Available at: clinicaltrials.gov/ct2/show/NCT02239640. Accessed: 5/17/12015.

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Conflict of Interest

AP Tansy declares no conflicts of interest. DS Liebeskind has received research support from NIH-NINDS and has served as a consultant for Covidien and Stryker.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to David S. Liebeskind.

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This article is part of the Topical Collection on Cardiovascular Disease and Stroke

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Tansy, A.P., Liebeskind, D.S. Imaging Acute Ischemic Stroke: Mapping Present and Future Clinical Practice. Curr Atheroscler Rep 17, 50 (2015). https://doi.org/10.1007/s11883-015-0531-8

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  • DOI: https://doi.org/10.1007/s11883-015-0531-8

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