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Revisit Diagnosis and Treatment of Acute Stroke: Myth and Truth

Post time: 2014-06-04 14:09:11      Page views:

 Revisit Diagnosis and Treatment of Acute Stroke: Myth and Truth
William Yuh, Ph.D. (Professor and Vice Chair of Department of Radiology at the University of Washington)

The gold standards for managing acute stroke has been verymuch the same for decades and traditionallybasedupon the ischemic duration , size of the ischemia (NIHSS or size of abnormal imaging) and risk factors (age, HTN, DM, etc.). With the introduction of t-PA, and advancement instroke imaging, and endovascular/mechanicalreperfusiondevice/technique, there are promising hopes to further improveoutcomes of acute stroke. However, controversial remains including the standard inclusion criteria intriagingacute stroke therapy. Furthermore,recent JNEM article reported that mechanical recanalization did not provide better outcome than those by IV t-PA. This talk will revisit the current stroke imaging protocolsand the decades’ old standards for the management of acute stroke patients. These includeusing DWI/PI mismatching for the assessment of ischemic Penumbra and triaging of stroke treatment based upon the fixed 3-6 hours’ therapeuticwindow.  Furthermore, the current concept of “Time is Brain” and its urgency to salvage penumbra may overshadow the principle of “Do no Harm” to avoid hemorrhagic complication.

Not until we can reliablydetermine the ischemic tissue being alive (viability) or salvageable (reversibility) immediatelybefore triaging a proper therapeutic option, current approach in treatingacute stroke may not be personalized and its treatment outcome including the hemorrhagic complicationmay seem to be a statistical games. This presentation will provide an overview of the functional imaging modalities, including ultra-high field MRI (7 and 8 T), and their potential integration into therapy paradigms for the treatment ofacute ischemicstroke.