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Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers

In acute stroke management, time window has been rigidly used as a guide for decades and the reperfusion treatment is only available in the first few limited hours. Recently, imaging-based selection of patients has successfully expanded the treatment window out to 16 and even 24 h in the DEFUSE 3 an...

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Autores principales: Lu, Jianfei, Mei, Qiyong, Hou, Xianhua, Manaenko, Anatol, Zhou, Lili, Liebeskind, David S., Zhang, John H., Li, Yao, Hu, Qin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497192/
https://www.ncbi.nlm.nih.gov/pubmed/34630278
http://dx.doi.org/10.3389/fneur.2021.697779
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author Lu, Jianfei
Mei, Qiyong
Hou, Xianhua
Manaenko, Anatol
Zhou, Lili
Liebeskind, David S.
Zhang, John H.
Li, Yao
Hu, Qin
author_facet Lu, Jianfei
Mei, Qiyong
Hou, Xianhua
Manaenko, Anatol
Zhou, Lili
Liebeskind, David S.
Zhang, John H.
Li, Yao
Hu, Qin
author_sort Lu, Jianfei
collection PubMed
description In acute stroke management, time window has been rigidly used as a guide for decades and the reperfusion treatment is only available in the first few limited hours. Recently, imaging-based selection of patients has successfully expanded the treatment window out to 16 and even 24 h in the DEFUSE 3 and DAWN trials, respectively. Recent guidelines recommend the use of imaging techniques to guide therapeutic decision-making and expanded eligibility in acute ischemic stroke. A tissue window is proposed to replace the time window and serve as the surrogate marker for potentially salvageable tissue. This article reviews the evolution of time window, addresses the advantage of a tissue window in precision medicine for ischemic stroke, and discusses both the established and emerging techniques of neuroimaging and their roles in defining a tissue window. We also emphasize the metabolic imaging and molecular imaging of brain pathophysiology, and highlight its potential in patient selection and treatment response prediction in ischemic stroke.
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spelling pubmed-84971922021-10-09 Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers Lu, Jianfei Mei, Qiyong Hou, Xianhua Manaenko, Anatol Zhou, Lili Liebeskind, David S. Zhang, John H. Li, Yao Hu, Qin Front Neurol Neurology In acute stroke management, time window has been rigidly used as a guide for decades and the reperfusion treatment is only available in the first few limited hours. Recently, imaging-based selection of patients has successfully expanded the treatment window out to 16 and even 24 h in the DEFUSE 3 and DAWN trials, respectively. Recent guidelines recommend the use of imaging techniques to guide therapeutic decision-making and expanded eligibility in acute ischemic stroke. A tissue window is proposed to replace the time window and serve as the surrogate marker for potentially salvageable tissue. This article reviews the evolution of time window, addresses the advantage of a tissue window in precision medicine for ischemic stroke, and discusses both the established and emerging techniques of neuroimaging and their roles in defining a tissue window. We also emphasize the metabolic imaging and molecular imaging of brain pathophysiology, and highlight its potential in patient selection and treatment response prediction in ischemic stroke. Frontiers Media S.A. 2021-09-23 /pmc/articles/PMC8497192/ /pubmed/34630278 http://dx.doi.org/10.3389/fneur.2021.697779 Text en Copyright © 2021 Lu, Mei, Hou, Manaenko, Zhou, Liebeskind, Zhang, Li and Hu. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Lu, Jianfei
Mei, Qiyong
Hou, Xianhua
Manaenko, Anatol
Zhou, Lili
Liebeskind, David S.
Zhang, John H.
Li, Yao
Hu, Qin
Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers
title Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers
title_full Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers
title_fullStr Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers
title_full_unstemmed Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers
title_short Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers
title_sort imaging acute stroke: from one-size-fit-all to biomarkers
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497192/
https://www.ncbi.nlm.nih.gov/pubmed/34630278
http://dx.doi.org/10.3389/fneur.2021.697779
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