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Imaging After Thrombolysis and Thrombectomy: Rationale, Modalities and Management Implications

  • Stroke (H.C. Diener, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Urgent reperfusion treatment with intravenous thrombolysis or mechanical thrombectomy reduces disability after ischaemic stroke. Imaging plays an important role in identifying patients who benefit, particularly in extended time windows. However, the role of post-treatment neuroimaging is less well established. We review recent advances in neuroimaging after reperfusion treatment and provide a practical guide to the options and management implications.

Recent Findings

Post-treatment imaging is critical to identify patients with reperfusion-related haemorrhage and oedema requiring intervention. It also can guide the timing and intensity of antithrombotic medication. The degree of reperfusion on post-thrombectomy angiography and infarct volume and topography using CT or MRI carry important prognostic significance. Perfusion-weighted MRI and permeability analysis may help detect persistent perfusion abnormalities post-treatment and predict haemorrhagic complications.

Summary

Post-treatment neuroimaging provides clinically relevant information to identify complications, assess prognosis and perform quality assurance after acute ischaemic stroke. Recent advances in neuroimaging represent a potential avenue to explore post-reperfusion pathophysiology and uncover therapeutic targets for secondary ischaemic and haemorrhagic injury.

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Authors and Affiliations

  1. Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC, 3050, Australia

    Felix C. Ng & Bruce C. V. Campbell

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  1. Felix C. Ng
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  2. Bruce C. V. Campbell
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Correspondence to Bruce C. V. Campbell.

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Glossary

IVT

Intravenous thrombolysis

LVO

Large vessel occlusion

EVT

Endovascular thrombectomy

NCCT

Non-contrast computed tomography

MRI

Magnetic resonance imaging

DSA

Digital subtraction angiography

AOL

Arterial occlusion lesion

IMS

Interventional Management of Stroke study

RCT

Randomised control trials

mTICI

Modified treatment in cerebral ischaemia score

HERMES

Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials

sICH

Symptomatic intracerebral haemorrhage

BBB

Blood-brain barrier

HT

Haemorrhagic transformation

ECASS

European Cooperative Acute Stroke Study

HI

Haemorrhagic infarction

PH

Parenchymal haematoma

DECT

Dual-energy CT

GRE

Gradient echo

SWI

Susceptibility-weighted imaging

CTP

CT perfusion

MCA

Middle cerebral artery

MLS

Midline shift

DWI

Diffusion-weighted imaging

DLR

Diffusion lesion reversal

ADC

Apparent diffusion coefficient

MRP

MR perfusion

DEFUSE

Diffusion and perfusion imaging evaluation for understanding stroke evolution study

EPITHET

Echoplanar Imaging Thrombolytic Evaluation Trial

FLAIR

Fluid-attenuated inversion recovery

HARM

Hyperintense acute reperfusion marker

DCE

Dynamic contrast-enhanced MRI

DSC

Dynamic susceptibility contrast MRI

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Ng, F.C., Campbell, B.C.V. Imaging After Thrombolysis and Thrombectomy: Rationale, Modalities and Management Implications. Curr Neurol Neurosci Rep 19, 57 (2019). https://doi.org/10.1007/s11910-019-0970-7

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  • DOI: https://doi.org/10.1007/s11910-019-0970-7

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