Patient Selection for Thrombectomy Using Brain Imaging: Does Time Still Matter?. (24th May 2022)

• Record Type: Journal Article
• Authors: Carrera, Emmanuel; Baron, Jean-Claude
• Is Part Of: Neurology. Volume 98:Number 21(2022)
• Page Start: 867
• Page End: 868
• Publication Date: 2022-05-24
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000200719
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Time is brain. For decades, this was the only dogma for acute ischemic stroke management and, until recently, the role of brain imaging prior to IV thrombolysis was mainly limited to exclusion of brain hemorrhage. However, several randomized clinical trials have revived the importance of brain imaging and placed perfusion and diffusion imaging at the center of acute stroke treatment, particularly for patient selection in late time windows (i.e., > 6 hours after known onset) or when time of symptom onset is unknown. 1 The ability to select patients for IV thrombolysis and endovascular treatment based on acute imaging creates a strong temptation to shift from the "time is brain" to the personalized "imaging is brain" paradigm. 2 Effectively, if the regions already destined to infarction (the ischemic core) and those at risk of infarction (the ischemic penumbra) can be accurately delineated based on acute imaging in any given patient, why continue to choose the therapeutic strategy based on time elapsed from onset or from last known well?