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Imaging Selection for Reperfusion Therapy in Acute Ischemic Stroke

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Opinion statement

Neuroimaging is essential in the evaluation of the acute stroke patient. Computed tomography (CT) or magnetic resonance imaging (MRI) should be used to confirm the diagnosis of acute stroke, exclude stroke mimics, and triage patients for intravenous tissue plasminogen activator and endovascular revascularization therapies. Advanced neuroimaging techniques, including CT-angiography, MR-angiography, CT-perfusion, and MR-perfusion should be used to further inform acute stroke treatment decisions. Patients considered for endovascular stroke therapy should have (1) a vascular occlusion that can be reached by an endovascular approach; (2) a small area of core cerebral infarction; and (3) viable tissue at risk of infarction if prompt revascularization is not achieved (penumbra).

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Jeremy J. Heit and Max Wintermark declare no conflicts of interest.

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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 Max Wintermark MD.

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Heit, J.J., Wintermark, M. Imaging Selection for Reperfusion Therapy in Acute Ischemic Stroke. Curr Treat Options Neurol 17, 4 (2015).

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  • Neuroimaging
  • Reperfusion therapy
  • Acute ischemic stroke
  • Tissue plasminogen activator
  • tPA
  • Endovascular revascularization
  • CT
  • MRI
  • Diagnosis
  • Treatment