UPDATED ACUTE ISCHEMIC STROKE TREATMENT ALGORITHM IN PROLONGED TIME WINDOWS USING ADVANCED NEUROIMAGING

Authors

Apostolos Safouris
Georgios Magoufis
Οdysseas Kargiotis
Klearchos Psychogios
Εleftherios Stamboulis
Georgios Tsivgoulis

Keywords:

Ischemic stroke, intravenous thrombolysis, mechanical thrombectomy, advanced neuroimaging, CT perfusion, MR perfusion

Abstract

A series of recent randomized-controlled phase III clinical trials evaluating the efficacy of acute reperfusion therapies in acute ischemic stroke (AIS) patients have expanded the time window for both intravenous thrombolysis (beyond 4.5 hours) and mechanical thrombectomy (beyond 6 hours) with the use of advanced neuroimaging (CT or MR perfusion, Diffusion-FLAIR mismatch). This narrative review aims to summarize these novel data, highlight the paramount role of advanced neuroimaging techniques for selecting the appropriate candidates for acute reperfusion therapies in delayed time windows and propose updated treatment protocols incorporating the protocols of the recent positive trials. In brief, the present review outlines the broad range of new opportunities to treat successfully with reperfusion therapies AIS patients based on ischemic tissue and not time thresholds.