Perfusion imaging has revolutionized acute stroke care by enabling tissue-based selection of treatment strategies. Historically, reperfusion treatments like thrombolysis were limited to strict time windows based on the assumption that salvageable brain tissue (the ischemic penumbra) existed only briefly. However, advanced imaging studies showed that some patients maintain viable penumbra beyond these limits.

Perfusion imaging (with CT or MRI) distinguishes ischemic "core" from salvageable "penumbra," guiding decisions for both thrombolysis and endovascular thrombectomy (EVT) while also improving our understanding of mechanistic processes to maintain the viability of penumbra, such as quantifying collateral status. Over the past two decades, key clinical trials validated this approach – from early MRI mismatch studies to landmark trials (EXTEND-IA, DAWN, DEFUSE 3) that extended thrombectomy up to 24 hours for selected patients. Today, perfusion imaging is central to acute stroke decision-making, allowing physicians to "think in terms of tissue, not time."

The Opening Main Event will offer a Welcome from the AHA's Chief Executive Office and the ISC 2026 Program Chair in addition to the AHA Presidential Address, the Feinberg Award Lecture, and the results from several high profile randomized clinical trials.

The Opening Main Event will offer a Welcome from the AHA's Chief Executive Office and the ISC 2026 Program Chair in addition to the AHA Presidential Address, the Feinberg Award Lecture, and the results from several high profile randomized clinical trials.