Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy
The ischemic penumbra is defined as the severely hypoperfused, functionally impaired, at-risk but not yet infarcted tissue that will be progressively recruited into the infarct core. Early reperfusion aims to save the ischemic penumbra by preventing infarct core expansion and is the mainstay of acut...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.861913/full |
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| author | Lucie Chalet Lucie Chalet Timothé Boutelier Thomas Christen Dorian Raguenes Justine Debatisse Omer Faruk Eker Omer Faruk Eker Guillaume Becker Norbert Nighoghossian Norbert Nighoghossian Tae-Hee Cho Tae-Hee Cho Emmanuelle Canet-Soulas Laura Mechtouff Laura Mechtouff |
| author_facet | Lucie Chalet Lucie Chalet Timothé Boutelier Thomas Christen Dorian Raguenes Justine Debatisse Omer Faruk Eker Omer Faruk Eker Guillaume Becker Norbert Nighoghossian Norbert Nighoghossian Tae-Hee Cho Tae-Hee Cho Emmanuelle Canet-Soulas Laura Mechtouff Laura Mechtouff |
| author_sort | Lucie Chalet |
| collection | DOAJ |
| description | The ischemic penumbra is defined as the severely hypoperfused, functionally impaired, at-risk but not yet infarcted tissue that will be progressively recruited into the infarct core. Early reperfusion aims to save the ischemic penumbra by preventing infarct core expansion and is the mainstay of acute ischemic stroke therapy. Intravenous thrombolysis and mechanical thrombectomy for selected patients with large vessel occlusion has been shown to improve functional outcome. Given the varying speed of infarct core progression among individuals, a therapeutic window tailored to each patient has recently been proposed. Recent studies have demonstrated that reperfusion therapies are beneficial in patients with a persistent ischemic penumbra, beyond conventional time windows. As a result, mapping the penumbra has become crucial in emergency settings for guiding personalized therapy. The penumbra was first characterized as an area with a reduced cerebral blood flow, increased oxygen extraction fraction and preserved cerebral metabolic rate of oxygen using positron emission tomography (PET) with radiolabeled O2. Because this imaging method is not feasible in an acute clinical setting, the magnetic resonance imaging (MRI) mismatch between perfusion-weighted imaging and diffusion-weighted imaging, as well as computed tomography perfusion have been proposed as surrogate markers to identify the penumbra in acute ischemic stroke patients. Transversal studies comparing PET and MRI or using longitudinal assessment of a limited sample of patients have been used to define perfusion thresholds. However, in the era of mechanical thrombectomy, these thresholds are debatable. Using various MRI methods, the original penumbra definition has recently gained a significant interest. The aim of this review is to provide an overview of the evolution of the ischemic penumbra imaging methods, including their respective strengths and limitations, as well as to map the current intellectual structure of the field using bibliometric analysis and explore future directions. |
| first_indexed | 2024-12-22T06:44:30Z |
| format | Article |
| id | doaj.art-b8ba53310c1e438f875712b5d11206b8 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-22T06:44:30Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-b8ba53310c1e438f875712b5d11206b82022-12-21T18:35:19ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-03-01910.3389/fcvm.2022.861913861913Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical ThrombectomyLucie Chalet0Lucie Chalet1Timothé Boutelier2Thomas Christen3Dorian Raguenes4Justine Debatisse5Omer Faruk Eker6Omer Faruk Eker7Guillaume Becker8Norbert Nighoghossian9Norbert Nighoghossian10Tae-Hee Cho11Tae-Hee Cho12Emmanuelle Canet-Soulas13Laura Mechtouff14Laura Mechtouff15Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, FranceOlea Medical, La Ciotat, FranceOlea Medical, La Ciotat, FranceGrenoble Institut Neurosciences, INSERM, U1216, Univ. Grenoble Alpes, Grenoble, FranceOlea Medical, La Ciotat, FranceUniv Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, FranceCREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, Villeurbanne, FranceNeuroradiology Department, Hospices Civils of Lyon, Lyon, FranceUniv Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, FranceUniv Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, FranceStroke Department, Hospices Civils of Lyon, Lyon, FranceUniv Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, FranceStroke Department, Hospices Civils of Lyon, Lyon, FranceUniv Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, FranceUniv Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, FranceStroke Department, Hospices Civils of Lyon, Lyon, FranceThe ischemic penumbra is defined as the severely hypoperfused, functionally impaired, at-risk but not yet infarcted tissue that will be progressively recruited into the infarct core. Early reperfusion aims to save the ischemic penumbra by preventing infarct core expansion and is the mainstay of acute ischemic stroke therapy. Intravenous thrombolysis and mechanical thrombectomy for selected patients with large vessel occlusion has been shown to improve functional outcome. Given the varying speed of infarct core progression among individuals, a therapeutic window tailored to each patient has recently been proposed. Recent studies have demonstrated that reperfusion therapies are beneficial in patients with a persistent ischemic penumbra, beyond conventional time windows. As a result, mapping the penumbra has become crucial in emergency settings for guiding personalized therapy. The penumbra was first characterized as an area with a reduced cerebral blood flow, increased oxygen extraction fraction and preserved cerebral metabolic rate of oxygen using positron emission tomography (PET) with radiolabeled O2. Because this imaging method is not feasible in an acute clinical setting, the magnetic resonance imaging (MRI) mismatch between perfusion-weighted imaging and diffusion-weighted imaging, as well as computed tomography perfusion have been proposed as surrogate markers to identify the penumbra in acute ischemic stroke patients. Transversal studies comparing PET and MRI or using longitudinal assessment of a limited sample of patients have been used to define perfusion thresholds. However, in the era of mechanical thrombectomy, these thresholds are debatable. Using various MRI methods, the original penumbra definition has recently gained a significant interest. The aim of this review is to provide an overview of the evolution of the ischemic penumbra imaging methods, including their respective strengths and limitations, as well as to map the current intellectual structure of the field using bibliometric analysis and explore future directions.https://www.frontiersin.org/articles/10.3389/fcvm.2022.861913/fullcerebral metabolic rate of oxygenMRIPETischemic thresholdspenumbrathrombolysis |
| spellingShingle | Lucie Chalet Lucie Chalet Timothé Boutelier Thomas Christen Dorian Raguenes Justine Debatisse Omer Faruk Eker Omer Faruk Eker Guillaume Becker Norbert Nighoghossian Norbert Nighoghossian Tae-Hee Cho Tae-Hee Cho Emmanuelle Canet-Soulas Laura Mechtouff Laura Mechtouff Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy Frontiers in Cardiovascular Medicine cerebral metabolic rate of oxygen MRI PET ischemic thresholds penumbra thrombolysis |
| title | Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy |
| title_full | Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy |
| title_fullStr | Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy |
| title_full_unstemmed | Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy |
| title_short | Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy |
| title_sort | clinical imaging of the penumbra in ischemic stroke from the concept to the era of mechanical thrombectomy |
| topic | cerebral metabolic rate of oxygen MRI PET ischemic thresholds penumbra thrombolysis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.861913/full |
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