Abstract
It is necessary to obtain neurovascular imaging to make treatment decision of revascularization therapy for acute ischemic stroke. Within 4.5 hours of onset, thrombolytic therapy using recombinant tissue-plasminogen activator (rt-PA) is considered if patients with large core are excluded. For this purpose, early ischemic changes on CT or diffusion weighted imaging (DWI) described as low ASPECTS or ASPECTS+W, respectively, is the key finding. DWI has high sensitivity to ischemia than CT, however, difference in detection characteristics needs to be considered and display method should be standardized. Simultaneously, vessel imaging should be performed to explore candidates for endovascular therapy. Recent randomized controlled trials, such as ESCAPE, EXTEND-IA and SWIFT PRIME, confirmed the presence of target vessel occlusion for stent retrievers, small core, and good collateral or tissue at risk. They are the key for successful outcomes. To improve our current rapid MRI first diagnostic system, or to change our strategy to CT first (CTA/multiphase CTA/CT perfusion) style that is common internationally, we need to consider.
