Which Imaging Approach Should Be Used for Stroke of Unknown Time of Onset?

TY - JOUR

T1 - Which Imaging Approach Should Be Used for Stroke of Unknown Time of Onset?

AU - Simonsen, Claus Z

AU - Leslie-Mazwi, Thabele M

AU - Thomalla, Götz

PY - 2021/1

Y1 - 2021/1

N2 - Reperfusion therapy with intravenous thrombolysis or mechanical thrombectomy is effective in improving outcome for ischemic stroke but remains underused. Patients presenting with stroke of unknown onset are a common clinical scenario and a common reason for not offering reperfusion therapy. Recent studies have demonstrated the efficacy of reperfusion therapy in stroke of unknown time of onset, when guided by advanced brain imaging. However, translation into clinical practice is challenged by variability in the available data. Comparison between studies is difficult because of use of different imaging modalities (magnetic resonance imaging or computed tomography), different imaging paradigms (imaging biomarkers of lesion age versus imaging biomarkers of tissue viability), and different populations studied (ie, both patients with large vessel occlusion or those with less severe strokes). Physicians involved in acute stroke care are faced with the key question of which imaging approach they should use to guide reperfusion treatment for stroke with unknown time of onset. In this review, we provide an overview of the available evidence for selecting and treating patients with strokes of unknown onset, based on the underlying imaging concepts. The perspective provided is from the viewpoint of the clinician seeing these patients acutely, to provide pragmatic recommendations for clinical practice.

AB - Reperfusion therapy with intravenous thrombolysis or mechanical thrombectomy is effective in improving outcome for ischemic stroke but remains underused. Patients presenting with stroke of unknown onset are a common clinical scenario and a common reason for not offering reperfusion therapy. Recent studies have demonstrated the efficacy of reperfusion therapy in stroke of unknown time of onset, when guided by advanced brain imaging. However, translation into clinical practice is challenged by variability in the available data. Comparison between studies is difficult because of use of different imaging modalities (magnetic resonance imaging or computed tomography), different imaging paradigms (imaging biomarkers of lesion age versus imaging biomarkers of tissue viability), and different populations studied (ie, both patients with large vessel occlusion or those with less severe strokes). Physicians involved in acute stroke care are faced with the key question of which imaging approach they should use to guide reperfusion treatment for stroke with unknown time of onset. In this review, we provide an overview of the available evidence for selecting and treating patients with strokes of unknown onset, based on the underlying imaging concepts. The perspective provided is from the viewpoint of the clinician seeing these patients acutely, to provide pragmatic recommendations for clinical practice.

KW - Biomarkers

KW - Humans

KW - Neuroimaging/methods

KW - Reperfusion

KW - Stroke/diagnostic imaging

KW - Thrombolytic Therapy

KW - Time-to-Treatment

KW - Treatment Outcome

U2 - 10.1161/STROKEAHA.120.032020

DO - 10.1161/STROKEAHA.120.032020

M3 - SCORING: Review article

C2 - 33302796

VL - 52

SP - 373

EP - 380

JO - STROKE

JF - STROKE

SN - 0039-2499

IS - 1

ER -