Acute Ischemic Stroke: Time, Penumbra, and Reperfusion
Stroke Reports Friday, February 7th, 2014STROKEAHA: January 7, 2014
Current guidelines advocate intravenous thrombolysis for patients with ischemic stroke <4.5 hours from onset without additional imaging beyond noncontrast computed tomography (CT) of the brain.1 Rapid administration of intravenous tissue-type plasminogen activator (IV-tPA) will reduce disability. Treatment of patients within 3 hours has an odds ratio of 1.53 (95% confidence interval, 1.26–1.86) for a favorable outcome (modified Rankin scale [mRS], 0–2) at 3 months.2However, this represents an absolute increase of 9% compared with placebo and is available to a minority of patients with ischemic stroke because of the rigid time constraints.3 Modern stroke imaging grants unprecedented access to the pathophysiology in individual patients with stroke. Time remains of key importance with respect to patient outcomes. However, it is now possible to not only routinely visualize the causative occlusion, but also estimate the ischemic core, the penumbral tissue at risk if reperfusion does not occur, and the state of the collateral blood supply. Read More
