Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY (A.A.B., S.N.).
Department of Neurology, Cooper University Hospital, Cooper Medical School at Rowan University, Camden, NJ (A.A.B., T.G.J.).
Stroke. 2024 Dec;55(12):2909-2920. doi: 10.1161/STROKEAHA.124.047384. Epub 2024 Sep 5.
While imaging has traditionally played a fundamental role in the selection of patients undergoing endovascular thrombectomy, recent thrombectomy trials involving patients with large ischemic strokes demonstrated a consistent benefit of endovascular thrombectomy across all imaging strata, suggesting that reperfusion benefit may exist independent of current imaging constructs. Although these findings attest to the uniformly beneficial effects of reperfusion, they also shed doubt on the accuracy and utility of our imaging modalities in defining reversible versus irreversible ischemia and challenge the premise of imaging-based selection. We aimed to review the histopathologic studies and clinical trials that have shaped our understanding of current imaging constructs aiming to outline the existing imaging-neuropathological gap that may be far wider than previously perceived.
虽然影像学在血管内血栓切除术患者的选择中一直发挥着重要作用，但最近涉及大缺血性卒中患者的血栓切除术试验表明，血管内血栓切除术在所有影像学分层中均具有一致的益处，这表明再灌注获益可能独立于当前的影像学构建。尽管这些发现证明了再灌注的普遍有益作用，但它们也对我们的影像学模式在定义可逆性与不可逆性缺血方面的准确性和实用性提出了质疑，并对基于影像学的选择提出了挑战。我们旨在回顾塑造我们对当前影像学构建理解的组织病理学研究和临床试验，旨在概述现有的影像学-神经病理学差距，该差距可能比之前认为的要大得多。
