Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging
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Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging. / Goyal, Mayank; Ospel, Johanna M; Menon, Bijoy; Almekhlafi, Mohammed; Jayaraman, Mahesh; Fiehler, Jens; Psychogios, Marios; Chapot, Rene; van der Lugt, Aad; Liu, Jianmin; Yang, Pengfei; Agid, Ronit; Hacke, Werner; Walker, Melanie; Fischer, Urs; Asdaghi, Negar; McTaggart, Ryan; Srivastava, Padma; Nogueira, Raul G; Moret, Jacques; Saver, Jeffrey L; Hill, Michael D; Dippel, Diederik; Fisher, Marc.
in: STROKE, Jahrgang 51, Nr. 10, 10.2020, S. 3147-3155.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging
AU - Goyal, Mayank
AU - Ospel, Johanna M
AU - Menon, Bijoy
AU - Almekhlafi, Mohammed
AU - Jayaraman, Mahesh
AU - Fiehler, Jens
AU - Psychogios, Marios
AU - Chapot, Rene
AU - van der Lugt, Aad
AU - Liu, Jianmin
AU - Yang, Pengfei
AU - Agid, Ronit
AU - Hacke, Werner
AU - Walker, Melanie
AU - Fischer, Urs
AU - Asdaghi, Negar
AU - McTaggart, Ryan
AU - Srivastava, Padma
AU - Nogueira, Raul G
AU - Moret, Jacques
AU - Saver, Jeffrey L
AU - Hill, Michael D
AU - Dippel, Diederik
AU - Fisher, Marc
PY - 2020/10
Y1 - 2020/10
N2 - Endovascular treatment is a highly effective therapy for acute ischemic stroke due to large vessel occlusion and has recently revolutionized stroke care. Oftentimes, ischemic core extent on baseline imaging is used to determine endovascular treatment-eligibility. There are, however, 3 fundamental issues with the core concept: First, computed tomography and magnetic resonance imaging, which are mostly used in the acute stroke setting, are not able to precisely determine whether and to what extent brain tissue is infarcted (core) or still viable, due to variability in tissue vulnerability, the phenomenon of selective neuronal loss and lack of a reliable gold standard. Second, treatment decision-making in acute stroke is multifactorial, and as such, the relative importance of single variables, including imaging factors, is reduced. Third, there are often discrepancies between core volume and clinical outcome. This review will address the uncertainty in terminology and proposes a direction towards more clarity. This theoretical exercise needs empirical data that clarify the definitions further and prove its value.
AB - Endovascular treatment is a highly effective therapy for acute ischemic stroke due to large vessel occlusion and has recently revolutionized stroke care. Oftentimes, ischemic core extent on baseline imaging is used to determine endovascular treatment-eligibility. There are, however, 3 fundamental issues with the core concept: First, computed tomography and magnetic resonance imaging, which are mostly used in the acute stroke setting, are not able to precisely determine whether and to what extent brain tissue is infarcted (core) or still viable, due to variability in tissue vulnerability, the phenomenon of selective neuronal loss and lack of a reliable gold standard. Second, treatment decision-making in acute stroke is multifactorial, and as such, the relative importance of single variables, including imaging factors, is reduced. Third, there are often discrepancies between core volume and clinical outcome. This review will address the uncertainty in terminology and proposes a direction towards more clarity. This theoretical exercise needs empirical data that clarify the definitions further and prove its value.
KW - Brain/diagnostic imaging
KW - Brain Ischemia/diagnostic imaging
KW - Fibrinolytic Agents/therapeutic use
KW - Humans
KW - Magnetic Resonance Imaging
KW - Stroke/diagnostic imaging
KW - Thrombolytic Therapy
KW - Tomography, X-Ray Computed
U2 - 10.1161/STROKEAHA.120.030620
DO - 10.1161/STROKEAHA.120.030620
M3 - SCORING: Review article
C2 - 32933417
VL - 51
SP - 3147
EP - 3155
JO - STROKE
JF - STROKE
SN - 0039-2499
IS - 10
ER -