Quelle imagerie à la phase aiguë de l'accident vasculaire cérébral ischémique antérieur à l'heure du traitement endovasculaire ?

Until recently, intravenous thrombolysis was the most effective therapy for the acute phase of ischemic stroke. Nonenhanced computed tomography (CT) and brain magnetic resonance imaging (MRI) with diffusion and T2 * weighted images are the preferred imaging for patient's selection. MR CLEAN, EXTEND-IA, ESCAPE, SWIFT PRIME, REVASCAT, THERAPY and THRACE studies have shown the superiority of endovascular treatment + thrombolysis versus thrombolysis alone in cases of proximal occlusion of the anterior cerebral circulation. CT angiography and magnetic resonance angiography (MRA) are sufficient to locate the thrombus and to assess the cervical and intracranial vessels. Additional techniques for measurement of the volume of the ischemic core, measurement of the volume of penumbra, and estimation of cerebral collateral vascularization are important to improve patient selection for interventional neuroradiology. In this article, we will present the available imaging techniques and specify their contribution and limitations. This overview should help neurologists, radiologists and interventional neuroradiologists to adapt the imaging techniques to specific situations.