Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewMR Imaging Selection of Acute Stroke Patients with Emergent Large Vessel Occlusions for Thrombectomy.
Acute stroke caused by large vessel occlusions (LVOs) are common. The time window to treat is up to 24 hours, and the most important factor is the size of the ischemic core. ⋯ The necessary sequences are obtainable rapidly, comparable to computed tomography scans. Available evidence suggests that most patients with LVOs are slow progressors defined as having a small core 6 hours or more after ictus onset.
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Teleradiology, transfer of radiology images to a distant diagnostician, has existed for more than 50 years and is a fundamental element in telestroke programs. Teleradiology allows access to expertise for accurate and rapid interpretation of noncontrast CT (NCCT) scans to distinguish ischemic stroke from hemorrhagic stroke. ⋯ Innovations in CT software and ambulance-based CT scans are significantly improving outcomes by matching patients to effective treatment paradigms. This article reviews telestroke models, NCCT interpretation pearls, and access challenges to the latest neuroradiology technology within rural and underserved regions.
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Given the need for early restoration of blood flow and preservation of partially damaged brain cells after ischemic stroke, the noninterventional treatment of stroke relies heavily on the speedy recognition and classification of the clinical syndrome. Initiation of systemic thrombolysis with careful observation of contraindications within the 3.0 (4.5)-hour time window is the approved therapy of choice. Management of hemorrhagic complications and resumption of oral anticoagulation if indicated are also discussed in this article.
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewAdvanced Neuroimaging of Acute Ischemic Stroke: Penumbra and Collateral Assessment.
Acute ischemic stroke (AIS) occurs when there is a sudden loss in cerebral blood flow due to embolic or thromboembolic occlusion of a cerebral or cervical artery. Patients with AIS require emergent neuroimaging to guide treatment, which includes intravenous thrombolysis and endovascular mechanical thrombectomy (EMT). Recent advances in AIS treatment by EMT has been driven in part by advances in computed tomography (CT) and MR imaging neuroimaging evaluation of ischemic penumbra and pial collateral vessels. The authors review advanced noninvasive brain imaging by CT and MR imaging for the evaluation of AIS focusing on penumbral and collateral imaging.
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Neuroimaging Clin. N. Am. · Nov 2018
ReviewNeuro-Interventional Management of Acute Ischemic Stroke.
Restoration of cerebral blood flow is the most important step in preventing irreversible damage to hypoperfused brain cells after ischemic stroke from large-vessel occlusion. For those patients who do not respond to (or are not eligible for) intravenous thrombolysis, endovascular therapy has become standard of care. ⋯ At this time, one can reasonably anticipate that more patients will be treated, and that outcomes will keep improving. This article discusses in detail recent advances in endovascular stroke therapy.