ACA: anterior carotid artery; ASPECTS: Alberta Stroke Program Early CT Score; CT: computed tomography; CTA: computed tomography angiography; CTP: computed tomography perfusion; DSA: digital subtraction angiography; DWI: diffusion-weighted magnetic resonance imaging; ICA: internal carotid artery; LVO: large vessel (artery) occlusion; MCA: middle cerebral artery; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; mRS: modified Rankin Scale; MT: mechanical thrombectomy; NIHSS: National Institutes of Health Stroke Scale; PWI: perfusion-weighted magnetic resonance imaging.
* All patients with acute ischemic stroke should be simultaneously evaluated for treatment with intravenous thrombolysis; refer to UpToDate topics for details.
¶ Urgent imaging is usually done with CT and CTA, less often with MRI and MRA.
Δ Advanced imaging is not essential but can be used at centers with CTP or DWI/PWI and automated software imaging analysis to determine infarct volume; patients can be selected for MT if they have salvageable brain tissue with a mismatch between a relatively larger area of hypoperfusion (ischemic penumbra) and a smaller area of irreversibly injured brain tissue (infarct core). Refer to UpToDate text for details.
◊ There is intracranial arterial occlusion of the distal ICA, or the M1 or proximal M2 segment of the MCA, as shown by CTA, MRA, or DSA.
§ MT may be a treatment option at expert stroke centers for patients with basilar artery LVO, but benefit is uncertain.Do you want to add Medilib to your home screen?