Clinical and Radiographic Considerations in Acute Stroke Triage

Despite approaching a 90 % rate of recanalization, good clinical outcomes are only seen in about 50 % of the patients who undergo stroke intervention. This discrepancy indicates that the recanalization of the artery does not always result in good clinical outcome. Also a subset of patients will not have any significant clinical improvement despite achieving early or late recanalization (Broderick et al., N Engl J Med 368:893–903, 2013; Kidwellet al., N Engl J Med 368:914–923, 2013). Therefore, there is a need to more accurately identify patients who will benefit from early or late recanalization using interventional therapy. Clinical assessment scales like National Institutes of Health Stroke Scale (NIHSS) and Houston Intra-arterial Therapy (HIAT) score can help identify patients with moderate to severe strokes, who may benefit from interventional therapies. The evolution of CT and MR imaging in conjunction with clinical assessment may allow us to further refine our ability to identify subgroups of patients who benefit from stroke intervention. These clinical and imaging criteria for patient selection are the focus of discussion in this chapter.