Challenging the Ischemic Core Concept in Acute Ischemic Stroke Imaging

Mayank Goyal, Johanna M. Ospel, Bijoy Menon, Mohammed Almekhlafi, Mahesh Jayaraman, Jens Fiehler, Marios Psychogios, Rene Chapot, Aad Van Der Lugt, Jianmin Liu, Pengfei Yang, Ronit Agid, Werner Hacke, Melanie Walker, Urs Fischer, Negar Asdaghi, Ryan Mctaggart, Padma Srivastava, Raul G. Nogueira, Jacques MoretJeffrey L. Saver, Michael D. Hill, Diederik Dippel, Marc Fisher

Research output: Contribution to journalReview articlepeer-review

10 Scopus citations


Endovascular treatment is a highly effective therapy for acute ischemic stroke due to large vessel occlusion and has recently revolutionized stroke care. Oftentimes, ischemic core extent on baseline imaging is used to determine endovascular treatment-eligibility. There are, however, 3 fundamental issues with the core concept: First, computed tomography and magnetic resonance imaging, which are mostly used in the acute stroke setting, are not able to precisely determine whether and to what extent brain tissue is infarcted (core) or still viable, due to variability in tissue vulnerability, the phenomenon of selective neuronal loss and lack of a reliable gold standard. Second, treatment decision-making in acute stroke is multifactorial, and as such, the relative importance of single variables, including imaging factors, is reduced. Third, there are often discrepancies between core volume and clinical outcome. This review will address the uncertainty in terminology and proposes a direction towards more clarity. This theoretical exercise needs empirical data that clarify the definitions further and prove its value.

Original languageEnglish (US)
Pages (from-to)3147-3155
Number of pages9
StateAccepted/In press - 2020


  • computed tomography
  • magnetic resonance imaging
  • thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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