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Thrombolytic therapy in patients with acute stroke has demonstrated efficacy in large randomized trials.1,2 However, the administration of IV tissue plasminogen activator (IV tPA) is not risk-free. Hemorrhagic transformation (HT) is a major complication associated with thrombolytic treatment for acute ischemic stroke. The current guidelines for patient selection and evaluation are based on CT imaging; however, an increasing number of stroke centers use MRI as the primary imaging modality for acute stroke management. This may represent the new gold standard for detecting both primary brain hemorrhage and secondary HT. Nevertheless, the identification and exclusion of patients with increased risk for HT remain major challenges for diagnostic imaging before treatment. The use of multimodal MRI criteria may therefore be useful for patient selection.3,4
Current guidelines for administering IV tPA restrict use in patients with prior symptomatic ischemic stroke, but do not cover those with recent silent ischemia (RSI), especially when detected by MRI. Further, data on the incidence of RSI identified on pretherapeutic MRI and on the influence of RSI …
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