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REVIEW ARTICLE

Unveiling the complexity of acute ischemic stroke through imaging and neuropathological insights

Lilan Wang1 ,  Changwei Guo1 ,  Qingwu Yang1*
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1 Department of Neurology, Second Affiliated Hospital of Army Medical University, Chongqing, China
Advanced Neurology, 025260075 https://doi.org/10.36922/AN025260075
Received: 23 June 2025 | Revised: 8 September 2025 | Accepted: 10 September 2025 | Published online: 26 September 2025
(This article belongs to the Special Issue Advanced Neurology 3rd Anniversary Special Issue)
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Effective management of acute ischemic stroke requires timely recanalization of occluded cerebral vessels, restoration of perfusion to the ischemic penumbra, and minimization of infarct volume. At present, clinicians rely heavily on various imaging modalities to evaluate the ischemic penumbra and core. However, the current imaging techniques often fail to accurately reflect the underlying cellular and histopathological changes associated with ischemia and lack standardized assessment criteria. This may lead to inconsistencies in diagnosis and treatment, ultimately compromising patient outcomes. Consequently, there is an urgent need to refine these imaging methods to better reflect the dynamic pathophysiology of cerebral ischemia. This review addresses these critical issues by first examining the shortcomings of current imaging approaches in assessing the ischemic penumbra and core. It highlights the discrepancies in these assessments and their implications for clinical practice. Furthermore, it proposes that integrating quantitative measures of salvageable ischemic regions with imaging-based molecular markers can enhance the precision of delineating the ischemic penumbra and core, thereby facilitating improved therapeutic decision-making. Finally, this review explores emerging biomarkers identified through the analysis of molecular and cellular mechanisms triggered by ischemia and hypoxia, underscoring their potential role in future diagnostics. Future imaging methods should strive to bridge the gap between microscopic cellular and molecular events and reliable imaging markers, ultimately enabling the identification of ischemic regions through biomarkers.

Keywords
Acute ischemic stroke
Ischemic penumbra
Ischemic core
Funding
This work was supported by the Chongqing Science and Health Joint Medical Science and Technology Innovation Four Major Projects (2023GGXM007); the National Science and Technology Major Project of the Ministry of Science and Technology of China (2024ZD0527900); and the National Natural Science Foundation of China (82090040).
Conflict of interest
The authors declare that they have no competing interests.
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing
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