title: Imaging-based selection for revascularization in acute ischemic stroke.
abstract: OBJECTIVE
  With the positive results of recent endovascular thrombectomy (EVT) trials, intravenous thrombolysis (IVT) and EVT provide physicians with two majorly effective acute treatment options for patients with acute ischemic stroke. IVT and EVT can be used as a single treatment or as a combined IVT/EVT treatment approach. This review summarizes how imaging findings can help in selecting stroke patients who are likely to benefit from these revascularization therapies.
  
  
  RESULTS
  IVT applied within 4.5 h from symptom onset remains the mainstay of acute stroke therapy and was also applied to most patients in the randomized EVT trials. Recent studies have failed to demonstrate the effectiveness of IVT in later time windows. Vascular imaging is crucial to identify patients with a target intracranial occlusion prior to EVT. Patients with a small ischemic core, with good leptomeningeal collaterals or with evidence of penumbral tissue may particularly benefit from EVT. These imaging findings may also identify patients who benefit from EVT if applied more than 6 h from symptom onset.
  
  
  CONCLUSIONS
  Pretherapeutic imaging findings help in identifying stroke patients who are likely to benefit from endovascular stroke therapies, and may identify patients who benefit from revascularization therapies in later time windows.
authors.affiliation: aDepartment of Neurology, Technische Universität Dresden, Dresden University Stroke Centre, Dresden, Germany bDepartment of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia cDepartment of Neuroradiology, Technische Universität Dresden, Dresden University Stroke Centre, Dresden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
authors.forename: Bruce
authors.initials: B
authors.lastname: Campbell
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linn
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Gerber
mesh_terms: D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator