Abstract
Evidence-based medicine has emerged as a valuable tool to guide clinical decision-making, by summarizing the best possible evidence for both diagnostic and treatment strategies. Imaging plays a critical role in the evaluation and treatment of patients with acute ischemic stroke, especially those who are being considered for thrombolytic or endovascular therapy. Time from stroke-symptom onset to treatment is a strong predictor of long-term functional outcome after stroke. Therefore, imaging and treatment decisions must occur rapidly in this setting, while minimizing unnecessary delays in treatment. The aim of this review was to summarize the best available evidence for the diagnostic and therapeutic management of patients with acute ischemic stroke.
Highlights
The aim of this review is to summarize the best available evidence for the diagnostic and therapeutic management of patients with acute ischemic stroke
The results indicated benefit for the treated group with 40% of r-proUK patients compared with 25% of control patients achieving the primary outcome measure of a modified Rankin Scale score of 0 –2, with similar mortality rates
CT has been used as the first-line imaging to assess ICH in patients with acute stroke
Summary
In this era of health care reform and cost containment, major concerns have been raised regarding inappropriate medical expenditures and the lack of data to support the necessity of such high levels of health care spending. Great emphasis has been placed on the necessity for evidence-based practice to guide clinical decision-making, especially in light of limited financial resources and increased public awareness of imaging-related safety concerns, including risks from radiation and contrast administration. Evidence-based practice is defined as “integration of the best research evidence with clinical expertise and patient values.”. When strong evidence is not available, clinical expertise and judgment play a major role in medical decision-making. The aim of this review is to summarize the best available evidence for the diagnostic and therapeutic management of patients with acute ischemic stroke. The first part of this review synthesizes the most current evidence on the appropriate indications and modalities to consider in the diagnostic work-up of patients with acute stroke. For patients who do not meet the criteria for IV thrombolysis but who arrive at the hospital relatively early after stroke onset, emerging imaging goals include identifying brain tissue that is still viable and identifying the location of vascular occlusion when endovascular therapy is considered
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