"The mechanism of vessel obstruction is important in addressing therapeutic manoeuvres to both attempt to reverse or minimise the effects and to prevent future infarcts. Popular and simple aetiological classifications of ischaemic stroke include the TOAST classification, ASCOD classification and CISS classification 20,28. When no aetiology can be found for an ischaemic stroke of presumed embolic aetiology, the label of embolic stroke of undetermined source (ESUS) can be applied (please see that article for a suggested diagnostic work-up) 38."
"The mechanism of vessel obstruction is important in addressing therapeutic manoeuvres to both attempt to reverse or minimise the effects and to prevent future infarcts. Popular and simple aetiological classifications of ischaemic stroke include the TOAST classification, ASCOD classification and CISS classification 20,28. When no aetiology can be found for an ischaemic stroke of presumed embolic aetiology, the label of embolic stroke of undetermined source (ESUS) can be applied (please see that article for a suggested diagnostic work-up) 38."
"Management of ischaemic stroke has been rapidly evolving. What is presented below is based on the AHA 2026 Guideline for the early management of patients with acute ischaemic stroke 46."
"endovascular clot retrieval for large vessel occlusions - response graded with TICI/mTICI"
"Endovascular clot retrieval candidacy is assessed with CTA, characterising occlusion site (large vessel occlusion or medium vessel occlusion) and cervical vessel anatomy, including the presence of dissection, atherosclerotic stenosis, or anatomical variants that may complicate endovascular access 46. For patients presenting with stroke due to proximal large vessel occlusion of the internal carotid artery or M1 segment of the MCA, presenting within 6 hours of symptom onset, endovascular clot retrieval is recommended when the following imaging criteria are met: NIHSS score ≥6, pre stroke mRS 0-1, and ASPECTS 3-10 on non-contrast CT or DWI MRI 46. For patients with ASPECTS 0-2, endovascular clot retrieval may still be reasonable in selected patients aged"
"Endovascular clot retrieval candidacy is assessed with CTA, characterising occlusion site (large vessel occlusion or medium vessel occlusion) and cervical vessel anatomy, including the presence of dissection, atherosclerotic stenosis, or anatomical variants that may complicate endovascular access 46. For patients presenting with stroke due to proximal large vessel occlusion of the internal carotid artery or M1 segment of the MCA, presenting within 6 hours of symptom onset, endovascular clot retrieval is recommended when the following imaging criteria are met: NIHSS score ≥6, pre stroke mRS 0-1, and ASPECTS 3-10 on non-contrast CT or DWI MRI 46. For patients with ASPECTS 0-2, endovascular clot retrieval may still be reasonable in selected patients aged"
"automated CT perfusion mismatch: ischaemic core volume"
"MRI DWI/FLAIR mismatch: positive DWI with absence of FLAIR signal change in the same territory (WAKE-UP trial criteria)"
"DAWN criteria (6-24 hours): clinical-imaging mismatch based on discordance between NIHSS score and infarct core volume (assessed by CT perfusion or DWI MRI), stratified by age"
"NIHSS ≥10 at presentation"
"Transcranial Doppler ultrasound"
Expected headings
"Video - acute infarction"
"Immediate"
"Early hyperacute"
"Acute"
"Subacute"
"Chronic"
"Video - stroke evolution"
"CT perfusion"
"CT angiography"
"Multiphase or delayed CT angiography"
"Early hyperacute"
"Late hyperacute"
"Acute"
"Subacute"
"Chronic"
"Transcranial Doppler ultrasound"
"Acute management"
"Standard window"
"Extended window"
"Basilar artery occlusion"
"Long-term management"
"Prognosis"
"Complications"
"Risk factors for ischaemic stroke largely mirror the risk factors for atherosclerosis and include age, gender, family history, smoking, hypertension, hypercholesterolaemia, and diabetes mellitus."
"Long-term management of ischaemic stroke focuses on secondary prevention and rehabilitation. Secondary prevention is individualised to each patient depending on the aetiology of their stroke and their comorbidities 34. For example, secondary prevention may include antiplatelet therapy, anticoagulation (e.g. if atrial fibrillation), addressing cerebrovascular risk factors (e.g. hypertension, hyperlipidaemia, diabetes mellitus), management of internal carotid artery stenosis, and management of a patent foramen ovale 34."
"cardiac embolism (e.g. atrial fibrillation, ventricular aneurysm, endocarditis)"
"artery-to-artery (atherosclerotic) embolism (e.g. internal carotid artery stenosis, intracranial atherosclerotic disease, aortic atheroma)"
"the degree of grey-white differentiation loss can be quantified with the Alberta stroke programme early CT score (ASPECTS), which may be used to guide management (e.g. in endovascular therapy of large infarcts)"
"establishing stroke aetiology (e.g. atherosclerosis, dissection, carotid web, vertebral web, external compression)"
"assess endovascular access and potential limitation for endovascular treatment (e.g. tortuosity, stenosis, anatomical variants)"
"intravenous thrombolysis (e.g. alteplase, tenecteplase)"
"intra-arterial thrombolysis (e.g. alteplase, tenecteplase)"
"peripheral vestibular disorders (e.g. acute unilateral vestibulopathy)"
"Within minutes of arterial occlusion, DWI demonstrates increased signal and reduced ADC values 4,10. This correlates well with infarct core (for a detailed discussion of DWI and ADC in stroke see diffusion-weighted MRI in acute stroke). At this stage, the affected parenchyma appears normal on other sequences, although changes in flow will be detected (occlusion on MRA) and the thromboembolism may be detected (e.g. the susceptibility vessel sign on SWI). Slow or stagnant flow in vessels may also be detected as a loss of normal flow void and high signal on T2/FLAIR and T1 C+ (intravascular enhancement), and the presence of the prominent vessel sign on SWI may indicate poor collateralisation 23."
"time to treatment: both intravenous thrombolysis and endovascular clot retrieval demonstrate strong time-dependency; every 30-minute delay in treatment initiation is associated with measurable reductions in the probability of a good functional outcome"
"there are non-vascular perfusion abnormalities on CT perfusion (frequently cortical or thalamic hyperperfusion); isolated hypoperfusion alone can be present in post ictal changes, though typically milder and non-territorial in distribution 47"