However, for some wake-up strokes and for some anterior circulation strokes with large infarcts, DWI-MRI and FLAIR sequences are necessary to determine eligibility for thrombolytics and EVT, respectively [40,47]. In patients with renal insufficiency or x-ray contrast allergy, the combination TOF MRA to identify arterial occlusions and DWI-MRI head without IV contrast can identify patients eligible for EVT 6 to 24 hours without putting the patient at risk and inform subsequent therapeutic decisions [46,47,52]. MRI is a reasonable complementary examination used in the initial workup of a focal neurological deficit if LVO is excluded by CTA, when there are confounding imaging and clinical variables. MRV Head Without and With IV Contrast There is no relevant literature to support the use of MRV of the head in the evaluation of suspected ischemic stroke in the absence of specific suspicion for CVT. MRV Head Without IV Contrast There is no relevant literature to support the use of MRV of the head in the evaluation of suspected ischemic stroke in the absence of specific suspicion for CVT. US Duplex Doppler Carotid Artery Although sensitive and specific in the detection of extracranial vascular disease, duplex carotid Doppler does not provide the information necessary to determine eligibility for thrombolytics or EVT. US duplex carotid Doppler, which is noninvasive and is accurate in evaluating the degree of carotid stenosis, is a useful test for the evaluation of the extracranial vasculature to determine eligibility for CEA or stenting if this information has not already been obtained from other vascular imaging. [63,64]. Current AHA guidelines recommend noninvasive imaging of the cervical carotid arteries for patients with TIA or minor stroke who are candidates for CEA or stenting, within 48 hours of onset [12].
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. However, for some wake-up strokes and for some anterior circulation strokes with large infarcts, DWI-MRI and FLAIR sequences are necessary to determine eligibility for thrombolytics and EVT, respectively [40,47]. In patients with renal insufficiency or x-ray contrast allergy, the combination TOF MRA to identify arterial occlusions and DWI-MRI head without IV contrast can identify patients eligible for EVT 6 to 24 hours without putting the patient at risk and inform subsequent therapeutic decisions [46,47,52]. MRI is a reasonable complementary examination used in the initial workup of a focal neurological deficit if LVO is excluded by CTA, when there are confounding imaging and clinical variables. MRV Head Without and With IV Contrast There is no relevant literature to support the use of MRV of the head in the evaluation of suspected ischemic stroke in the absence of specific suspicion for CVT. MRV Head Without IV Contrast There is no relevant literature to support the use of MRV of the head in the evaluation of suspected ischemic stroke in the absence of specific suspicion for CVT. US Duplex Doppler Carotid Artery Although sensitive and specific in the detection of extracranial vascular disease, duplex carotid Doppler does not provide the information necessary to determine eligibility for thrombolytics or EVT. US duplex carotid Doppler, which is noninvasive and is accurate in evaluating the degree of carotid stenosis, is a useful test for the evaluation of the extracranial vasculature to determine eligibility for CEA or stenting if this information has not already been obtained from other vascular imaging. [63,64]. Current AHA guidelines recommend noninvasive imaging of the cervical carotid arteries for patients with TIA or minor stroke who are candidates for CEA or stenting, within 48 hours of onset [12].