We present the radiological findings of acute ischemic stroke seen in advanced imaging protocols, including computed tomography angiography (CTA) with perfusion and penumbra quantification, magnetic resonance imaging (MRI), and catheter angiography. We evaluate the existing treatment paradigms as well as current and experimental treatments beyond intravenous (IV) thrombolysis. We review the medical literature that details the treatment options after the 4.5 hour window for IV thrombolysis has closed and we examine the infrastructure needed to provide these advanced treatments.

We use case reviews collected at a tertiary referral center between 2006 and 2011 to illustrate all of these aspects of acute ischemic stroke. High-quality images are utilized to demonstrate the pertinent radiological findings.

I-INTRODUCTION AND EPIDEMIOLOGY Acute ischemic stroke is caused by disruption of blood flow to one or more regions of the brain by vessel occlusion in 80% of cases (1) or by acute hemorrhage from diseased vessels in 20% of cases. According to the “Instituto Nacional de Estadística” (INE) of Spain, cerebrovascular disease wasthe second most common cause of death in the Spanish population in the year 2006 (the latest year statistics were available at the time of writing), the first cause of death in the...

Acute ischemic stroke affects a significant portion of the population. The sequelae of stroke have a sizeable impact on patients’ quality of life and result in important societal costs, both in economic and humanitarian terms. Many acute ischemic stroke patients are not eligible for IV thrombolysis, thus, it is fundamental to be familiar with advanced diagnostic techniques and advanced treatment options such as IA thrombolysis. It is important to be up-to-date with the medical literature describing these advanced techniques. Finally it is useful to understand...

1. Enrique Marco de Lucas, Elena Sánchez, et al. CT Protocol for Acute Stroke: Tips and Tricks for General Radiologists. Radiographics 2008; 28:1673-1687. 2. Ministerio de Sanidad y Consumo de España. Estrategia en ictus del Sistema Nacional de Salud. Available at: http://www.semg.es/doc/documentos_SEMG/ estrategias_icuts_SNS.pdf. Accessed January 15th, 2012. 3. Bristol-Myers Squibb España. Ictus / Isquemia cerebral. Available at: https:// www.bms.es/wps/portal/BMS/TuSalud/Patologias/IctusIsquemiaCerebral. Accessed March 2nd, 2012. 4. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics-2010 update: a report from the American Heart Association....