Journal of Neuroradiology (2015) 42, 1—2

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EDITORIAL

Neuroradiology of acute stroke, where are we today?

Ischemic stroke is major public health issue according to the high number of patients involved as well as the high risk of death and neurological sequelae associated with this condition. The recent publication of the positive MR CLEAN results as well as the potential positive results of other trials (ESCAPE, Extend-IA. . .) will certainly have a tremendous impact of the management of patients with acute ischemic stroke [1]. In this context, this special issue of the Journal of Neuroradiology dedicated to the current concepts of diagnostic and interventional neuroradiology in cerebral ischemic stroke is very important. Twenty years were necessary since the publication of NINDS trial about IV rt-PA in AIS to establish the value of the endovascular treatment (EVT) in the management of AIS [1,2]. In parallel to therapeutic developments, new imaging techniques we progressively improving diagnostic of stroke (diffusion and perfusion imaging), identification of salvageable brain, identification of vascular occlusion, and selection of patients for acute treatment (IV or EVT). As the available, therapeutic approaches (IV rt-PA or EVT) has to be used in the first hours following stroke symptoms onset, it is now widely accepted that ischemic stroke is a medical emergency [1—3]. However, there are still a lot of questions regarding the imaging modalities for stroke, the role of imaging in the selection of patients for acute therapeutics, the modalities of the endovascular treatment [4—7]. It is the reason why we decided to have a special issue of the Journal of Neuroradiology dedicated to this important topic. Several international specialists have accepted to share their experience and knowledge in diagnostic and interventional neuroradiology in the management of AIS. Indeed, it is not possible to cover all issues related to the acute management of AIS, but this review will contributes to the important debates around this topic by covering most imaging and therapeutic modalities presented by different schools of thought in European and North American. http://dx.doi.org/10.1016/j.neurad.2015.02.001 0150-9861/© 2015 Published by Elsevier Masson SAS.

A question is: what is the appropriate modality for AIS? A first paper is analyzing in great details the respective value of both CT and MRI in AIS [8]. While CT has proven excellent for the detection of hemorrhage, there is no dispute of the advantage of MRI to detect clearly ischemia. In some countries, MRI has already become the accepted standard whereas in some there is still resistance to its use due to logistic problems more than diagnostic problems. However, the techniques are widely used to select patients for treatment [9]. Von Kummer et al. are subsequently analyzing the therapeutic efficacy of imaging in AIS patients [10]. While there has always been a heated debate on the utility of perfusion imaging for the demonstration of a putative penumbra or tissue at risk, Wintermark is analyzing in great details the techniques and potential value of Perfusion CT [11]. A second part is focused on therapeutic modalities of stroke. Remonda is describing the pharmacological recanalization therapy and Pereira et al. is presenting the current status of mechanical thrombectomy, but not including the results of the more recent trials as some of them are very recent and others unknown in details [12,13]. Finally, Souillard-Scemama et al. are showing that neuroimaging is critical in the evaluation of patients with Transient Ischemic Attack (TIA) and MRI is the recommended modality to image an ischemic lesion [14]. Overall, while there is a clear shift from CT to MRI for diagnostic and from intravenous to endovascular (or combined techniques) for treatment, we see that neuroradiology is a field becoming more and more complex that is fully involved with other clinical neurosciences in the management of AIS. Indeed, we have now moved from an era when stroke imaging meant simply hemorrhage exclusion to a time where we can assess tissue damage, hemodynamic, eventually the presence of collateral flow by techniques such as arterial spin labeling and then proceed to hyperacute treatment with an extensive armamentarium that will help us in improve clinical outcomes and patients’ quality of life. In

2 the last years, the Journal of Neuroradiology has extensively contributed to the development and understanding of all the new techniques by publishing a high number of manuscripts dedicated to these topics [15—30].

References [1] Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial for intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11—20. [2] The NINDS rt-PA stroke study group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581—7. [3] Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359(13):1317—29. [4] Lövblad KO, Altrichter S, Viallon M, Sztajzel R, Delavelle J, Vargas MI, et al. Neuro-imaging of cerebral ischemic stroke. J Neuroradiol 2008;35(4):197—209. [5] Emeriau S, Serre I, Toubas O, Pombourcq F, Oppenheim C, Pierot L. Can Diffusion-Weighted Imaging—Fluid-Attenuated Inversion Recovery Mismatch (Positive Diffusion-Weighted Imaging/Negative Fluid-Attenuated Inversion Recovery) at 3 Tesla Identify Patients With Stroke at < 4.5 Hours? Stroke 2013;44:1647—51. [6] Soize S, Kadziolka K, Estrade L, Serre I, Bakchine S, Pierot L. Mechanical thrombectomy in acute stroke: prospective pilot trial of the Solitaire FR device while under conscious sedation. AJNR Am J Neuroradiol 2013;34:360—5. [7] Soize S, Benaissa A, Wakhloo A, Pierot L. Techniques for endovascular treatment of acute ischemic stroke: from intraarterial fibrinolytics to stent-retrievers. Stroke 2015. [8] Lovblad KO, Altrichter S, Mendes Pereira V, Vargas M, Ana Marcos Gonzalez A, Haller S, et al. Imaging of acute stroke: CT and/or MRI. J Neuroradiol 2015. [9] Soize S, Naggara O, Desal H, Costalat V, Ricolfi F, Pierot L. Endovascular treatment of acute ischemic stroke in France: a nationwide survey. J Neuroradiol 2014;41:71—9. [10] von Kummer R, Dzialowski I, Gerber J. Therapeutic efficacy of brain imaging in acute ischemic stroke patients. J Neuroradiol 2015. [11] Donahue J, Wintermark M. Perfusion CT and Acute Stroke Imaging: Foundations, Applications, and Literature Review. J Neuroradiol 2015. [12] Hlavica M, Diepers M, Garcia-Esperon C, Ineichen B, Krassen Nedeltchev K, Kahles T, et al. Pharmacological recanalization therapy in acute ischemic stroke - Evolution, current state and perspectives of intravenous and intra-arterial thrombolysis. J Neuroradiol 2015. [13] Pereira VM, Yilmaz H, Pellaton A, Slater LA, Krings T, Lovblad KO. Current status of mechanical thrombectomy for acute stroke treatment. J Neuroradiol 2015. [14] Souillard-Scemama R, Tisserand M, Calvet D, Jumadilova D, Lion S, Turc G, et al. An update on brain imaging in transient ischemic attack. J Neuroradiol 2015. [15] Altrichter S, Kulcsar Z, Sekoranja L, Rüfenacht D, Viallon M, Lovblad KO. Arterial spin labeling demonstrates early recanalization after stroke. J Neuroradiol 2009;36(2):109—11. [16] Altrichter S, Kulcsar Z, Jägersberg M, Federspiel A, Viallon M, Schaller K, et al. Arterial spin labeling shows cortical collateral flow in the endovascular treatment of vasospasm after post-traumatic subarachnoid hemorrhage. J Neuroradiol 2009;36(3):158—61.

Editorial [17] Lettau M, Laible M. 3T high-b-value diffusion-weighted MR imaging in hyperacute ischemic stroke. J Neuroradiol 2013;40:149—57. [18] Raoult H, Eugène F, Ferré JC, Gentric JC, Ronzière T, Stamm A, et al. Prognostic factors for outcomes after mechanical thrombectomy with solitaire stent. J Neuroradiol 2013;40:252—9. [19] Lee WI, Mitchell P, Dowling R, Yan B. Clinical factors are significant predictors of outcome post intra-arterial therapy for acute ischaemic stroke: a review. J Neuroradiol 2013;40:315—25. [20] Lefevre PH, Lainay C, Thouant P, Chavent A, Kazemi A, Ricolfi F. Solitaire FR as a first-line device in acute intracerebral occlusion: a single-centre retrospective analysis. J Neuroradiol 2013;40:80—6. [21] Ract I, Ferré JC, Ronzière T, Leray E, Carsin-Nicol B, Gauvrit JY. Improving detection of ischemic lesions at 3 Tesla with optimized diffusion-weighted magnetic resonance imaging. J Neuroradiol 2014;41:45—51. [22] Martinon E, Lefevre PH, Thouant P, Osseby GV, Ricolfi F, Chavent A. Collateral circulation in acute stroke: assessing methods and impact: a literature review. J Neuroradiol 2014;41:97—107. [23] Soize S, Kadziolka K, Estrade L, Serre I, Barbe C, Pierot L. Outcome after mechanical thrombectomy using a stent retriever under conscious sedation: comparison between tandem and single occlusion of the anterior circulation. J Neuroradiol 2014;41:136—42. [24] Pierot L, Benaissa A, Pereira V, Lövblad KO. Future directions for endovascular management of patients with acute ischemic stroke. J Neuroradiol 2014;41:151—2. [25] Fustier A, Naggara O, Tisserand M, Touzé E, Mellerio C, Edjlali M, et al. Total mismatch in anterior circulation stroke patients before thrombolysis. J Neuroradiol 2014;41:158—63. [26] Yaghi S, Bianchi N, Amole A, Hinduja A. ASPECTS is a predictor of favorable CT perfusion in acute ischemic stroke. J Neuroradiol 2014;41:184—7. [27] Gawlitza M, Gragert J, Quäschling U, Hoffmann KT. FLAIRhyperintense vessel sign, diffusion-perfusion mismatch and infarct growth in acute ischemic stroke without vascular recanalisation therapy. J Neuroradiol 2014;41:234—42. [28] Donahue J, Sumer S, Wintermark M. Assessment of collateral flow in patients with cerebrovascular disorders. J Neuroradiol 2014;41:227—33. [29] Danière F, Edjlali-Goujon M, Mellerio C, Turc G, Naggara O, Tselikas L, et al. MR screening of candidates for thrombolysis: how to identify stroke mimics? J Neuroradiol 2014;41:283—95. [30] Bivard A, Levi C, Krishnamurthy V, Hislop-Jambrich J, Salazar P, Jackson B, et al. Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion. J Neuroradiol 2014;41:307—15.

Karl-Olof Lövblad ∗ Department of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland Laurent Pierot Department of Neuroradiology, CHU de Reims, Reims, France ∗

Corresponding author. Department of diagnostic and interventional neuroradiology, Geneva University Hospitals, 1204 Geneva, Switzerland. Tel.: +41 22 372 70 33; fax: +41 22 372 70 72. E-mail address: [email protected] (K.-O. Lövblad)

Neuroradiology of acute stroke, where are we today?

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