US Duplex Doppler Transcranial Transcranial Doppler may be useful, both in the detection of microembolic events and in the detection of intracranial vascular pathology. However, this is typically not an initial imaging test in the setting of stroke. Variant 5: Adult. Prior ischemic infarct. Surveillance imaging. After the initial ischemic injury is defined, identifying the presence of any complications such as hemorrhagic conversion or associated mass effect become the focus of evaluation of recent ischemic infarcts, which are both less emergent than identifying EVT candidates. The extent of the initial ischemic injury plays a key role in defining the risk for delayed complications and the need for and expected duration of ongoing surveillance. Ongoing ischemia or hemorrhagic complication may impact the timeline for initiation of anticoagulant and/or antiplatelet therapy. For large hemispheric or cerebellar infarcts, prolonged observation or early craniectomy may be indicated, which would Cerebrovascular Diseases-Stroke argue for delaying any preventative measures and/or treatments that pose a risk of operative bleeding [13]. If not previously performed during initial triage, cardiocerebrovascular assessment has a secondary but important clinical role. Arteriography Cervicocerebral Cerebral angiography has the highest spatial resolution and temporal resolution of any vascular study and may detect early progression of known steno-occlusive intracranial or cervical atherosclerotic disease before detection on other studies. As such, cerebral angiography may be useful in follow-up imaging in select ischemic strokes, particularly those in which the findings on noninvasive imaging are indeterminate. Cerebral angiography is typically reserved for diagnoses not excluded by less invasive modalities and even then is of uncertain specificity and sensitivity [66].
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. US Duplex Doppler Transcranial Transcranial Doppler may be useful, both in the detection of microembolic events and in the detection of intracranial vascular pathology. However, this is typically not an initial imaging test in the setting of stroke. Variant 5: Adult. Prior ischemic infarct. Surveillance imaging. After the initial ischemic injury is defined, identifying the presence of any complications such as hemorrhagic conversion or associated mass effect become the focus of evaluation of recent ischemic infarcts, which are both less emergent than identifying EVT candidates. The extent of the initial ischemic injury plays a key role in defining the risk for delayed complications and the need for and expected duration of ongoing surveillance. Ongoing ischemia or hemorrhagic complication may impact the timeline for initiation of anticoagulant and/or antiplatelet therapy. For large hemispheric or cerebellar infarcts, prolonged observation or early craniectomy may be indicated, which would Cerebrovascular Diseases-Stroke argue for delaying any preventative measures and/or treatments that pose a risk of operative bleeding [13]. If not previously performed during initial triage, cardiocerebrovascular assessment has a secondary but important clinical role. Arteriography Cervicocerebral Cerebral angiography has the highest spatial resolution and temporal resolution of any vascular study and may detect early progression of known steno-occlusive intracranial or cervical atherosclerotic disease before detection on other studies. As such, cerebral angiography may be useful in follow-up imaging in select ischemic strokes, particularly those in which the findings on noninvasive imaging are indeterminate. Cerebral angiography is typically reserved for diagnoses not excluded by less invasive modalities and even then is of uncertain specificity and sensitivity [66].