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Currently, many patients do not qualify for tPA therapy because they present for evaluation beyond 3 hours after stroke onset. Attempts to expand the treatment window to 6 hours, using CT to select patients, have failed. Use of early MR i maging may provide significant advantages over CT for identification of patients who are likely to benefit from thrombolytic therapy because (1) the early perfusion-weighted imaging (PWI) lesion estimates the region of acute dysfunctional brain tissue, wh ereas the acute diffusion-weighted imaging (DWI) lesion appears to correspond to the core of the early infarction; (2) the mismatch between the acute PWI lesion and the smaller DWI lesion represents potentially salvageable brain tissue (an estimate of the ischemic penumbra); and (3) in patients with a PWI/DWI mismatch, early reperfusion is often associated with substantial clinical improvement and reversal or reduction of DWI lesion growth. Clinical trials that use new MRI techniques to screen patients m ay be able to identify a subset of acute stroke patients who are ideal candidates for thrombolytic therapy even beyond 3 hours after stroke onset. |
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cerebrovascular accident
cerebrovascular accident,acute management of
cerebrovascular accident,thrombolytic agents in treatment
fibrinolytic agents
MRI
MRI,abnormal
MRI,cerebrovascular disease
MRI,diffusion weighted
MRI,early changes in CVA
MRI,mismatch between perfusion/diffusion
MRI,perfusion
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