Abstract
Acute ischemic stroke (AIS) is a common neurovascular emergency causing significant burden to society. Currently the main focus of AIS treatment is to restore blood flow to at risk brain tissue. For the last twenty years, intravenous tissue plasminogen activator (tPA) was the only proven therapy for patients with AIS. More recently, five randomized clinical trials established the efficacy of endovascular therapy with or without intravenous tPA in selected patient populations with AIS.Not all stroke patients benefit from intravenous tPA or endovascular treatment. Nonetheless, the concept of early recanalization of occluded arteries resulting in better clinical outcomes is well established. In this focused review, we will discuss how imaging modalities such as Non-Contrast CT, CT-Angiography, and CT-Perfusion can potentially help physicians determine which patients are likely to recanalize early with intravenous tPA and therefore benefit from this therapy.
Highlights
BackgroundStroke is the second leading cause of mortality worldwide [http://www.who.int/mediacentre/factsheets/fs310/ en/]
Theory of clot formation within intracranial arteries The pathophysiology of clot formation in myocardial infarction is secondary to plaque rupture and thrombosis in situ in 95% [7], while in ischemic stroke it is more diverse and multifactorial
The recent endovascular clinical trials established the superiority of endovascular therapy (EVT) over intravenous tissue plasminogen activator (IVT) in patients presenting with large vessel anterior circulation occlusions [2,3,4,5,6]
Summary
Stroke is the second leading cause of mortality worldwide [http://www.who.int/mediacentre/factsheets/fs310/ en/]. In acute ischemic stroke (AIS), clot lysis and early restoration of blood flow to ischemic brain tissue is the ultimate goal of all reperfusion therapies. The recent endovascular clinical trials established the superiority of endovascular therapy (EVT) over intravenous tissue plasminogen activator (IVT) in patients presenting with large vessel anterior circulation occlusions [2,3,4,5,6].
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