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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, Vol. 51, No. 10, 10.2020, p. 3147-3155.

Research output: SCORING: Contribution to journal › SCORING: Review article › Research

Harvard

Goyal, M, Ospel, JM, Menon, B, Almekhlafi, M, Jayaraman, M, Fiehler, J, Psychogios, M, Chapot, R, van der Lugt, A, Liu, J, Yang, P, Agid, R, Hacke, W, Walker, M, Fischer, U, Asdaghi, N, McTaggart, R, Srivastava, P, Nogueira, RG, Moret, J, Saver, JL, Hill, MD, Dippel, D & Fisher, M 2020, 'Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging', STROKE, vol. 51, no. 10, pp. 3147-3155. https://doi.org/10.1161/STROKEAHA.120.030620

APA

Goyal, M., Ospel, J. M., Menon, B., Almekhlafi, M., Jayaraman, M., Fiehler, J., Psychogios, M., Chapot, R., van der Lugt, A., Liu, J., Yang, P., Agid, R., Hacke, W., Walker, M., Fischer, U., Asdaghi, N., McTaggart, R., Srivastava, P., Nogueira, R. G., ... Fisher, M. (2020). Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging. STROKE, 51(10), 3147-3155. https://doi.org/10.1161/STROKEAHA.120.030620

Vancouver

Goyal M, Ospel JM, Menon B, Almekhlafi M, Jayaraman M, Fiehler J et al. Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging. STROKE. 2020 Oct;51(10):3147-3155. https://doi.org/10.1161/STROKEAHA.120.030620

Bibtex

@article{d2a0bb95e89f48ffa8966f7e2b53666a,
title = "Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging",
abstract = "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.",
keywords = "Brain/diagnostic imaging, Brain Ischemia/diagnostic imaging, Fibrinolytic Agents/therapeutic use, Humans, Magnetic Resonance Imaging, Stroke/diagnostic imaging, Thrombolytic Therapy, Tomography, X-Ray Computed",
author = "Mayank Goyal and Ospel, {Johanna M} and Bijoy Menon and Mohammed Almekhlafi and Mahesh Jayaraman and Jens Fiehler and Marios Psychogios and Rene Chapot and {van der Lugt}, Aad and Jianmin Liu and Pengfei Yang and Ronit Agid and Werner Hacke and Melanie Walker and Urs Fischer and Negar Asdaghi and Ryan McTaggart and Padma Srivastava and Nogueira, {Raul G} and Jacques Moret and Saver, {Jeffrey L} and Hill, {Michael D} and Diederik Dippel and Marc Fisher",
year = "2020",
month = oct,
doi = "10.1161/STROKEAHA.120.030620",
language = "English",
volume = "51",
pages = "3147--3155",
journal = "STROKE",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

RIS

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 -