From "Time is Brain" to "Imaging is Brain": A Paradigm Shift in the Management of Acute Ischemic Stroke

被引：78

作者：

Puig, Josep ^{[1
,2
]}

Shankar, Jai ^{[1
]}

Liebeskind, David ^{[3
,4
]}

Terceno, Mikel ^{[5
]}

Nael, Kambiz ^{[6
]}

Demchuk, Andrew M. ^{[7
]}

Menon, Bijoy ^{[7
]}

Dowlatshahi, Dar ^{[8
]}

Leiva-Salinas, Carlos ^{[9
]}

Wintermark, Max ^{[10
]}

Thomalla, Goetz ^{[11
]}

Silva, Yolanda ^{[5
]}

Serena, Joaquin ^{[5
]}

Pedraza, Salvador ^{[2
]}

Essig, Marco ^{[1
]}

机构：

[1] Univ Manitoba, Dept Radiol, Winnipeg, MB, Canada

[2] Hosp Univ Dr Josep Trueta IDIBGI, Dept Radiol, Girona, Spain

[3] Univ Calif Los Angeles, Dept Neurol, Neurovasc Imaging Res Core, Los Angeles, CA 90024 USA

[4] Univ Calif Los Angeles, Stroke Ctr, Los Angeles, CA USA

[5] Hosp Univ Girona Dr Josep Trueta IDIBGI, Dept Neurol, Girona, Spain

[6] Univ Calif Los Angeles, David Geffen Sch Med, Dept Radiol Sci, Los Angeles, CA 90095 USA

[7] Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci & Radiol, Calgary, AB, Canada

[8] Univ Ottawa, Ottawa Hosp Res Inst, Dept Med Neurol, Ottawa, ON, Canada

[9] Univ Missouri, Dept Radiol, Columbia, MO USA

[10] Stanford Univ, Sch Med, Neuroradiol Sect, Dept Radiol, Stanford, CA 94305 USA

[11] Univ Med Ctr Hamburg Eppendorf, Dept Neurol, Hamburg, Germany

来源：

JOURNAL OF NEUROIMAGING | 2020年 / 30卷 / 05期

关键词：

Acute ischemic stroke; computed tomography; endovascular thrombectomy; magnetic resonance imaging; randomized clinical trial; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; RAPID ENDOVASCULAR TREATMENT; HEALTH-CARE PROFESSIONALS; EARLY CT SCORE; INTERVENTIONAL MANAGEMENT; MECHANICAL THROMBECTOMY; INTRAVENOUS ALTEPLASE; LESION VOLUME; PERFUSION-CT; INTRAARTERIAL TREATMENT;

D O I：

10.1111/jon.12693

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Arterial recanalization to restore the blood supply and limit the brain damage is the primary goal in the management of acute ischemic stroke (AIS). Since the publication of pivotal randomized clinical trials in 2015, endovascular thrombectomy has become part of the standard of care in selected cases of AIS from large-vessel occlusions up to 6 hours after the onset of symptoms. However, the association between endovascular reperfusion and improved functional outcome is not strictly time dependent. Rather than on rigid time windows, candidates should be selected based on vascular and physiologic information. This approach places imaging data at the center of treatment decisions. Advances in imaging-based management of AIS provide crucial information about vessel occlusion, infarct core, ischemic penumbra, and degree of collaterals. This information is invaluable in identifying patients who are likely to benefit from reperfusion therapies and excluding those who are unlikely to benefit or are at risk of adverse effects. The approach to reperfusion therapies continues to evolve, and imaging is acquiring a greater role in the diagnostic work-up and treatment decisions as shown in recent clinical trials with extended time window. The 2018 American Heart Association/American Stroke Association guidelines reflect a paradigm shift in the management of AIS from "Time is Brain" to "Imaging is Brain." This review discusses the essential role of multimodal imaging developing from recent trials on therapy for AIS.

引用

页码：562 / 571

页数：10

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