25 Mar 21. Featured update: stroke

Imaging Advances: Acute-on-chronic stroke

Link to full update piece on Stroke AHA Journals

Authors

David S. Liebeskind, Joanna M. Wardlaw

Update piece

"In acute stroke, multimodal computed tomography (CT) & magnetic resonance imaging (MRI) protocols, fused with advanced postprocessing techniques for real-time interpretation via mobile phone, continued to flourish.

As each surge of the COVID-19 pandemic buffeted local resources across stroke systems of care, clinicians have been forced to make more from less, including using only noncontrast CT to detect ischemia, arterial occlusion, & hint at underlying perfusion patterns.

Following thrombolysis & thrombectomy, serial imaging has disclosed much more about the extent & quality of reperfusion in the early subacute period.

The earliest implementation of stroke prevention has also now been strengthened by imaging of small vessel disease, atherosclerosis, & other subtle clues about pivotal, often coexistent, vascular pathophysiology.

Despite the traditional approach to stroke imaging, where discrete phases (acute versus chronic) are assumed to dictate relevant imaging findings & solitary subtypes of stroke cause are presumed, acute-on-chronic lesions & mixed pathology are reality.

The most salient experiences of the past year drive next advances in imaging of stroke, as described in this brief update."

Keywords

• Acute stroke
• Brain health
• Cognition
• Imaging
• Reperfusion