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Imaging selection for reperfusion therapy in acute ischemic stroke beyond the conventional time window

Journal of Neurology volume 269, pages 1715–1723 (2022)Cite this article

Abstract

Originally, the efficacy of acute ischemic stroke treatment with thrombolysis or thrombectomy was only proven in narrow time windows of, respectively, 4.5 and 6 h after onset. Introducing imaging-based selection beyond non-contrast enhanced computed tomography has expanded the treatment window, focusing on presumed tissue status rather than solely on time after stroke onset. Different mismatch concepts have been adopted in clinical practice to select patients in the extended and unknown time window based on findings from randomized controlled trials. Since various concepts exist that can identify patients likely to benefit from reperfusion strategies, clinicians may wonder which imaging modality may be preferred in the emergency setting. In this review, we will discuss the different mismatch concepts and their practical implementation for patient selection for thrombolysis or thrombectomy, beyond the conventional time window.

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Acknowledgements

L.S. is supported by Research Foundation Flanders, PhD fellowship fundamental research 1193620N. R.L. is senior clinical investigator of Research foundation Flanders.

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Authors and Affiliations

  1. Department of Neurology, University Hospitals Leuven, Leuven, Belgium

    Lauranne Scheldeman, Anke Wouters & Robin Lemmens

  2. Department of Neurosciences, Experimental Neurology, KU Leuven, University of Leuven, Leuven, Belgium

    Lauranne Scheldeman, Anke Wouters & Robin Lemmens

  3. Center for Brain and Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium

    Lauranne Scheldeman, Anke Wouters & Robin Lemmens

  4. Neurology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands

    Anke Wouters

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  1. Lauranne Scheldeman
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LS, AW, and RL drafted and revised the manuscript.

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Correspondence to Lauranne Scheldeman.

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Conflicts of interest

L.S. reports grants from Research Foundation Flanders during the conduct of the study; other (congress participation) from Daiichi Sankyo outside the submitted work. R.L. has no personal disclosures, but reports consultancy fees paid to the institution from Ischemaview and Boehringer-Ingelheim. A.W. has nothing to report.

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Scheldeman, L., Wouters, A. & Lemmens, R. Imaging selection for reperfusion therapy in acute ischemic stroke beyond the conventional time window. J Neurol 269, 1715–1723 (2022). https://doi.org/10.1007/s00415-021-10872-4

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  • DOI: https://doi.org/10.1007/s00415-021-10872-4

Keywords

  • Ischemic stroke
  • Magnetic resonance imaging
  • Computed tomography
  • Reperfusion treatment