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Cerebral perfusion in acute stroke prognostication

Most patients improve after stroke. But when dealing with individuals, clinicians are challenged to predict whether, how much, and how soon that particular patient will recover. The best predictive tool for at least 40 years has been the presenting clinical examination—the odds and the extent of recovery decrease roughly proportionally to the initial clinical severity.1,2

Newer technologies incorporated into the stroke workup have enabled neurologists to forecast more accurately individual stroke outcomes. Imaging and quantifying the “real estate factor”—infarct location and size—adds some confidence to stroke outcome prediction.3 But how much does this information really tell us that we do not already know from examining the patient? More importantly, can we develop algorithms that not only improve prognostication, but also inform treatment?

Enter vascular- and flow-based imaging technologies. Visualizing acute large-vessel occlusion guides the use …