Advanced Imaging and Stroke Treatment

Advanced Imaging Identifies Patients Who Can Benefit From a New Extended Treatment Window

Most people can identify the signs of a heart attack, but stroke symptoms are less widely recognized.  Signs such as one-sided weakness and numbness, slurred speech, or sudden vision impairment could indicate a stroke, and timely treatment is critical to a good outcome.  

Even less widely known is that all hospitals and medical centers are not equal when it comes to the diagnosis and treatment of a stroke.  

Imaging capabilities are just one place where there are variations from center to center. While magnetic resonance imaging (MRI) and computed tomography (CT) are universally used to diagnose a stroke, a center with advanced imaging capabilities—such as CT or MR perfusion, functional MRI, and CT or MR spectroscopy—can retrieve a lot more information about the patient’s brain, such as whether and where tissue is still alive.    

“If tissue is already dead you wouldn't want to put the patient at risk,” says Angela Lignelli, MD, associate professor of radiology and chief of the Division of Neuroradiology at Columbia University Irving Medical Center (CUIMC). “If it's still alive you'd want to do everything you can to prevent the stroke from happening.”  

The most common type of stroke is called an ischemic stroke, which happens when a vessel supplying blood to the brain becomes obstructed by a clot. Recently, two studies have shown that some ischemic stroke patients can benefit from treatment up to 24 hours after symptoms first present themselves, much longer than the four-and-a-half-hour window that has traditionally guided stroke care. This extended treatment window could potentially be life-saving for stroke victims who live far away from hospitals, ignore their symptoms, or wake up with symptoms that began in their sleep.   

Advanced imaging is key to identifying which patients can benefit from treatment after four and a half hours have passed.   

Stroke patients who come to NewYork-Presbyterian Hospital/CUIMC will likely be imaged using RAPID™ CT perfusion, software that has been FDA approved for selecting stroke patients who are likely to benefit from endovascular thrombectomy (clot removal). A neuroradiologist using RAPID™ CT perfusion can quickly see which areas of the brain are adequately supplied with blood, or perfused—something that a regular MRI or CT image will not clearly show—and determine whether there is salvageable tissue in the patient’s brain.  

This level of imaging detail opens up a range of treatment possibilities.  

“Advanced imaging can delineate which patients are treatable,” Dr. Lignelli says, explaining that those patients will most likely be treated by a neurointerventional radiologist, who uses imaging guidance to perform thrombectomy.  "Not all centers have the ability to do what we do here.”  

Advanced imaging is just one of the things that sets Columbia apart.  Led by Dr. Philip Meyers and Dr. Sean Lavine, Columbia’s team of stroke specialists provides the most advanced interventional neuroradiology treatments available today, a level of care that isn't found at all centers.    

Columbia is a designated Comprehensive Stroke Center by the Joint Commission.  It is the highest level of certification possible and indicates a center’s ability to provide round-the-clock care for even the most complex stroke cases.