Type:
Educational Exhibit
Keywords:
Not applicable, Ischaemia / Infarction, Technical aspects, MR-Diffusion/Perfusion, CT-Angiography, CT, Neuroradiology brain, Interventional vascular, Neuro
Authors:
F. Giordano1, A. manto2, B. Carotenuto3, A. Serino4, M. Marseglia5, M. Ventra6; 1Mercato San Severino/IT, 2Nocera inferiore (sa)/IT, 3Boscoreale/IT, 4Nocera Inferiore, SA/IT, 5Napoli/IT, 6Nocera Inferiore/IT
DOI:
10.26044/ecr2020/C-04552
Background
Acute ischemic stroke is the third leading cause of mortality and the first cause of disability in the world. Ischemic stroke is a syndrome caused by the sudden reduction of arterial supply to the cerebral tissue. Generally, it is caused by the occlusion of an intracranial artery. In the ischemic territory it is possible to recognize severely hypoperfused brain tissue which has been damaged irreversibly (ischemic core) and the hypoperfused but still vital brain tissue (ischemic penumbra). This occurs thanks to a series of hemodynamic and metabolic mechanisms, which however tend to wear off over time Fig1.
In the last years the approach to acute ischemic stroke has radically changed due to the introduction of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). The aim of reperfusion therapies is to save the ischemic penumbra. The therapeutic window is about 4.5 hours for IVT and 6 hours for MT. The most recent randomized clinical trials (RCT), DAWN and DEFUSE 3, have extended the therapeutic window of MT to 16-24h in carefully selected patients.
It is clear that the correct classification and selection of the patient with acute ischemic stroke is necessary.
The classification and selection of the patient with acute ischemic stroke can be carried out both with the CT and with MRI. CT is more widespread in the area, is more rapid in execution and has no contraindications.
MRI is more sensitive than CT in recognizing the early signs of ischemia and in determining its extension, but generally requires longer times for the preparation of the patient and execution. Furthermore, MRI cannot be performed in all patients and it is not widespread in all hospital centers. For these reasons we will focus only on CT protocol.