Acute stroke imaging for thrombolytic therapy--an update.
More than ten years after its approval intravenous thrombolysis with rtPA still is the only approved therapy for acute ischemic stroke. In this review we aim to give an up-to-date overview of acute stroke imaging within and outside of approved indications for thrombolysis. We discuss the potential applications of modern CT techniques such as CT angiography and perfusion CT as well as stroke MRI for the selection-based treatment of acute ischemic stroke. Recent publications regarding diagnostic strength as well as new randomized trials and larger prospective but open studies are reviewed and discussed. Finally we present a suggestion for the selection of patients for thrombolysis within and beyond the 3-hour time window in the form of an institutional algorithm prioritizing according to present evidence and pathophysiological reasoning.
Köhrmann
Martin
M
Department of Neurology, University Hospital of Erlangen, Erlangen, Germany.
Jüttler
Eric
E
Huttner
Hagen B
HB
Nowe
Tim
T
Schellinger
Peter D
PD
D000208:Acute Disease; D000465:Algorithms; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D002533:Cerebral Angiography / Q000379:methods*; D004334:Drug Administration Schedule; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011994:Recombinant Proteins / Q000008:administration & dosage; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator