Advances in Stroke
Substantial advances have been made during the past 2 years in various applications of neuroimaging in stroke. Because of limited space, a few major areas in imaging are highlighted here, including developments in selection for acute stroke therapies, hemorrhage, and recovery.
Results from several clinical trials have provided important data about imaging selection, including the mismatch concept, for acute stroke reperfusion therapies. A post hoc analysis of the pooled EPITHET-DEFUSE (Echoplanar Imaging Thrombolytic Evaluation Trial and Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study) datasets found that alteplase in the 3- to 6-hour window attenuated infarct growth and increased reperfusion in mismatch patients compared with placebo. Clinical outcomes were associated with degree of reperfusion; however, there was no difference in mortality or outcome between treatment groups and no comparison with nonmismatch patients.1,2 Another secondary pooled analysis from all 3 of the desmoteplase trials suggested that defining mismatch with a minimum volume of 60 cc based on magnetic resonance imaging (MRI) alone showed a significant treatment effect for desmoteplase.3 Additionally, in patients with a visible occlusion on noninvasive vessel imaging at baseline, the …