Which imaging before reperfusion strategy?

Which imaging before reperfusion strategy? Rev Neurol (Paris). 2017 Oct 13;: Authors: Olivot JM Abstract The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. From 1995 to 2015, IV alteplase administered within 4.5hours after the onset of acute BI diagnosed by the absence of hemorrhage on a non-contrast head CT scan has been the only approved revascularization treatment. Over the past 2years, 6 randomized trials have confirmed the benefit of a thrombectomy performed within 6-8 hours after the onset of an acute anterior BI downstream of an ICA/M1 occlusion. The recommended imaging modality for such patients remains a NCCT to exclude an hemorrhage and a CTA to confirm the proximal vessel occlusion. As a consequence, in the absence of collateral or penumbral imaging, studies and meta-analyses, have emphasized the importance of treatment delay on the outcome of patient after a revascularisation treatment (tPA/thrombectomy). These findings have supported the development of mobile stroke unit for tPA administration and the dire...
Source: Revue Neurologique - Category: Neurology Tags: Rev Neurol (Paris) Source Type: research