WSC 2022 | When to use advanced stroke imaging to inform treatment decisions

Wim H. van Zwam, MD, Maastricht University Medical Center, Maastricht, The Netherlands, discusses the use of advanced imaging after acute ischemic stroke. CT and MRI are commonly used techniques to delineate the irreversibly damaged ischemic core from the hypoperfused penumbra, which has the potential to inform treatment decisions and identify patients most likely to benefit from endovascular therapy. In the early time window, perfusion imaging is not typically used given the time delay it imparts. The value of thrombectomy in patients within six hours of symptom onset is well established and thus, additional advanced imaging adds little to the decision-making process. Beyond the six-hour time point, there is less of a treatment benefit for thrombectomy. Therefore, it pays to use perfusion imaging to select patients more likely to benefit from treatment, giving patients the best chance of success without submitting those unlikely to respond to unnecessary risk. This interview took place at the World Stroke Congress 2022 in Singapore.

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