Guest Editorial

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Brain imaging is critical for the evaluation and treatment of acute ischemic stroke. Both computed tomography (CT) and magnetic resonance imaging (MRI) are standardly used to make the diagnosis of ischemic stroke, to exclude common ischemic stroke mimics, and to guide treatment decisions.1 Historically, the most important role of brain CT and MRI is the exclusion of intracranial hemorrhage, which is an absolute contraindication to treatment with intravenous thrombolysis. However, the role of brain imaging is rapidly changing in parallel with ischemic stroke treatment advances.
There has been a sea change in the treatment of ischemic stroke in the past 2 years with the unprecedented publication of 5 randomized trials that found an overwhelming benefit of endovascular mechanical thrombectomy for the treatment of stroke due to occlusion of a major cerebral artery.2–6 These endovascular trials have significant implications for radiologists, neuroradiologists, and other neuroimagers, as the advanced neuroimaging techniques used in most of these trials are being rapidly incorporated to neurointerventional practices around the world. Thus, the focus of brain imaging for acute ischemic stroke now must place a greater emphasis on patient selection for endovascular therapy, and it is essential for the neuroimaging community to understand the clinical and imaging questions a neurointerventionalist must answer before proceeding with endovascular stroke treatment in order to design appropriate and rapid neuroimaging protocols.
In these 2 issues of Topics in Magnetic Resonance Imaging, we present a series of articles to review the recent advances in acute ischemic stroke treatment, the advanced neuroimaging used for ischemic stroke evaluation, and how advanced neuroimaging is likely to be used in the future for the treatment of patients beyond standard treatment time windows. These articles are written by national and international leaders in ischemic stroke imaging and treatment, and I wish to sincerely thank all of these authors for their thorough, thoughtful, and timely contributions.

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