Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Special lectures
- Part II Oxidative stress
- Part III Apoptosis
- Part IV Hot topics
- Part V Hemorrhage, edema and secondary injury
- Part VI Inflammation
- Part VII Gene transfer and therapy
- Part VIII Neurogenesis and plasticity
- Part IX Magnetic resonance imaging in clinical stroke
- 28 Magnetic resonance imaging in stroke trials
- 29 Disappearing deficits and disappearing lesions: diffusion/perfusion MRI in transient ischemic attack and intra-arterial thrombolysis
- 30 Diffusion and perfusion magnetic resonance imaging in the evaluation of acute ischemic stroke
- 31 Early recanalization in acute ischemic stroke saves tissue at risk defined by stroke magnetic resonance imaging
- Part X Risk factors, clinical trials and new therapeutic horizons
- Index
- Plate section
31 - Early recanalization in acute ischemic stroke saves tissue at risk defined by stroke magnetic resonance imaging
from Part IX - Magnetic resonance imaging in clinical stroke
Published online by Cambridge University Press: 02 November 2009
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Special lectures
- Part II Oxidative stress
- Part III Apoptosis
- Part IV Hot topics
- Part V Hemorrhage, edema and secondary injury
- Part VI Inflammation
- Part VII Gene transfer and therapy
- Part VIII Neurogenesis and plasticity
- Part IX Magnetic resonance imaging in clinical stroke
- 28 Magnetic resonance imaging in stroke trials
- 29 Disappearing deficits and disappearing lesions: diffusion/perfusion MRI in transient ischemic attack and intra-arterial thrombolysis
- 30 Diffusion and perfusion magnetic resonance imaging in the evaluation of acute ischemic stroke
- 31 Early recanalization in acute ischemic stroke saves tissue at risk defined by stroke magnetic resonance imaging
- Part X Risk factors, clinical trials and new therapeutic horizons
- Index
- Plate section
Summary
Introduction
The target for most therapeutic interventions for focal ischemia should be ischemic tissue that can respond to treatment and is not irreversibly injured. Such tissue will be defined as potentially salvageable ischemic tissue and must be distinguished from non-salvageable ischemic tissue that has evolved to a status at which recovery is no longer possible. Characterization of potentially reversible vs. irreversible ischemic tissue is based on the ischemic penumbra hypothesis. Ideally, before any aggressive therapeutic approach (i.e., thrombolysis) is undertaken, four important questions concerning the individual stroke situation should be addressed using only one optimal diagnostic imaging procedure:
Does the patient have acute cerebral ischemia or is another underlying pathology responsible for the stroke symptoms (e.g., intracerebral hemorrhage, tumor)?
Is there already an area of irreversibly damaged ischemic tissue and what is the size of this infarct core?
Is there a tissue of risk (“penumbra”) that can be preserved from damage by therapeutic intervention, and what is the size of this area?
Is the vessel that is responsible for the ischemia still occluded or has there been a pontaneous recanalization?
The ideal imaging modality will be able to address all of these questions within an acceptable amount of time before a specific treatment is begun.
Diffusion-weighted imaging
Since the description of early findings in acute experimental ischemic stroke with diffusion-weighted imaging (DWI), it has been predicted that this technique might become an important tool for the identification of very early ischemic injury in patients.
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- Cerebrovascular Disease22nd Princeton Conference, pp. 381 - 390Publisher: Cambridge University PressPrint publication year: 2002