Acute ischemic stroke - Diagnostic imaging and interventional options

Stroke is the third most common cause of death after myocardial infarction and neoplasms in industrialized countries and the most common cause for permanent disability with impairment of an independent life style. In addition to the socioeconomic problems caused by a disabling stroke, it is to be expected that with an increasing average age of the population, the number of stroke patients will increase as well [4]. The need for effective and widely available therapies against this severe disease is highly evident. Diagnostic imaging is indispensable in order to apply these therapies efficiently and precisely. In addition to the established intravenous thrombolytic therapy with rt-PA within the first 3h, a therapeutic benefit can also be achieved with thrombolysis inside the time-window 3-6h, whereas the rate of symptomatic intracerebral hemorrhages increases. Local intraarterial fibrinolysis (LIF) within 6h is effective and safe and may lead to con-siderable improvement despite an initially severe medical condition [13]. Besides LIF, interventional techniques for mechanical recanalization of intracranial vessel occlusions are becoming increasingly more established. According to international guidelines for the treatment of acute stroke, computed tomography (CT) is considered to be the most important technical diagnostic tool if available round-the-clock. Alternatively, magnetic resonance tomography (MRT) may primarily be performed if carried out without delay and if the imaging protocol contains a sequence suitable for exclusion of hemorrhages.