Use of Imaging to Select Patients for Late Window Endovascular Therapy

Gregory W. Albers, MD


Stroke. 2018;49(9):2256-2260. 

In This Article

Estimating the Ischemic Core and Penumbra With MRI

If using MRI to select patients for late window thrombectomy, the DWI lesion is the recommended sequence to estimate the size of the ischemic core. Automated software programs typically use an ADC threshold to identify tissue with severely restricted water proton movement. Studies have suggested that an ADC threshold of <620×10−3 mm/s identifies tissue that is highly likely to be irreversibly injured.[12] Just as in CTP, the Tmax >6 seconds perfusion parameter is often used to estimate tissue that is likely to progress to infarction if reperfusion does not occur. The mismatch between the acute DWI lesion volume and the Tmax >6 seconds lesion volume estimates salvageable tissue.[8–10]