Role of neuroimaging before reperfusion therapy. Part 1 – IV thrombolysis – Review

García-Esperón, Carlos; Raposo, Nicolas; Seners, Pierre; Spratt, Neil J; Olivot, Jean‐Marc

doi:10.1016/j.neurol.2020.10.007

Cited by 1 publication

(1 citation statement)

References 105 publications

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“…In 1996, tPA (i.e., alteplase) was licensed as AIS therapy. However, it was restricted to patients with known symptom onset within a narrow time window of three hours [ 14 ]. In 2008, the European Cooperative Acute Stroke Study (ECASS)-3 trial demonstrated the efficacy of intravenous thrombolysis (IVT) with alteplase up to 4.5 hours after symptoms onset [ 15 ].…”

Section: Reviewmentioning

confidence: 99%

Reperfusion Therapies in Acute Ischemic Stroke Beyond the Conventional Time Window: A Narrative Review

Mansour

2023

Cureus

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Stroke is the second most common cause of death worldwide, with 50% of survivors experiencing long-term disability. For more than two decades, treatment with intravenous thrombolysis (IVT) and mechanical endovascular thrombectomy (MET), the only approved stroke reperfusion therapies, was restricted to patients within the 4.5-6 hour time window, respectively. Therefore, patients who presented with acute ischemic stroke (AIS) beyond the conventional time window were excluded from reperfusion treatment. This narrative review aims to review the scientific literature on the possibilities of reperfusion therapies for patients who present with an unknown time of stroke onset, and those with stroke onset beyond the conventional 4.5-6 hour time window. Beyond the conventional time window, the eligibility of patients for IVT or MET, the two main therapeutic procedures, is decided based on the concept of penumbral imaging. Penumbral imaging identifies patients with hypoperfused but viable brain tissue, who could benefit from reperfusion. On the other hand, clock-based DWI-fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) can detect stroke that has occurred within 4.5 hours in patients with an unknown time of onset, including patients who awaken with stroke. The introduction of penumbral imaging and MRIbased tissue clocking as imaging biomarkers for stroke has revolutionized stroke therapy, potentially allowing for personalized treatment of eligible stroke patients.

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Section: Reviewmentioning

confidence: 99%

Reperfusion Therapies in Acute Ischemic Stroke Beyond the Conventional Time Window: A Narrative Review

Mansour

2023

Cureus

View full text Add to dashboard Cite

show abstract

Role of neuroimaging before reperfusion therapy. Part 1 – IV thrombolysis – Review

Cited by 1 publication

References 105 publications

Reperfusion Therapies in Acute Ischemic Stroke Beyond the Conventional Time Window: A Narrative Review

Reperfusion Therapies in Acute Ischemic Stroke Beyond the Conventional Time Window: A Narrative Review

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