Neuroradiology Insights on the Updated AHA/ASA Guideline for Management of Acute Ischemic Stroke

For neuroradiologist and neurointerventionalist Jeremy Heit, M.D., Ph.D., the most significant change in the updated acute ischemic stroke (AIS) guideline from the American Heart Association (AHA) and the American Stroke Association (ASA) is the extended window of thrombolysis from 4.5 to nine hours from onset with the use of diffusion weighted imaging-fluid attenuated recovery or perfusion-based mismatch.

In a recent interview with Diagnostic Imaging, Jeremy Heit, M.D., Ph.D., said the ability to offer a more extended window of thrombolysis for patients with AIS is a “very exciting” development after being “stuck” with a zero to 4.5-hour time window for many years.

“The guidelines say if you are a patient on perfusion imaging who has evidence of salvageable tissue, let's treat you with intravenous thrombolysis and now up to nine hours from last known well. That's huge. You're basically doubling our current treatment windows, and that's going to impact a lot of patients, and it should lead to better outcomes in patients,” emphasized Dr. Heit, the chief of neuroimaging and neurointervention at the Stanford University School of Medicine.

Dr. Heit said another key change in the AHA/ASA guideline is the recommendation for thrombectomy with MRI guidance in pediatric patients with AIS.

“Many of us have been doing that since we've been in practice, but we haven't had really a recommendation or a guidance on doing that. It just seemed reasonable. So that is really great to see, and specifically that they're recommending MRI guidance in that population. I think that that is making the field good stewards of pediatric patients by minimizing radiation exposure,” added Dr. Heit, an associate professor of radiology and neurosurgery at the Stanford University School of Medicine.

(Editor’s note: For related content, see “Stroke MRI Study Assesses Impact of Motion Artifacts Upon AI and Radiologist Lesion Detection,” “A Closer Look at the Potential of AI Foundation Models for Brain MRI” and “Is AI Better than Neuroradiologists at Evaluating Aneurysm Growth on CTA and MRA Scans?”)