Advanced Imaging for Extended Window Stroke Therapy

Acute ischemic stroke (AIS) results from occlusion of a cervical or cerebral artery and may cause significant neurologic deficits. Treatments for AIS include intravenous thrombolysis or endovascular thrombectomy, and both of these treatments are guided by the time from symptom onset and non-invasive brain imaging parameters. Advanced neuroimaging techniques, such as computed tomography and magnetic resonance imaging-cerebral perfusion imaging, are predominantly used to guide AIS treatments in extended time windows (>4.5 h for intravenous thrombolysis or >6 h for endovascular thrombectomy). Here, we discuss the role of advanced neuroimaging for AIS patient treatment in extended time windows based upon the current evidence.