Late Thrombectomy in Clinical Practice

Abstract Background and Purpose To provide real-world data on outcome and procedural factors of late thrombectomy patients. Methods We retrospectively analyzed patients from the multicenter German Stroke Registry. The primary endpoint was clinical outcome on the modified Rankin scale (mRS) at 3 months. Trial-eligible patients and the subgroups were compared to the ineligible group. Secondary analyses included multivariate logistic regression to identify predictors of good outcome (mRS ≤ 2). Results Of 1917 patients who underwent thrombectomy, 208 (11%) were treated within a time window ≥ 6–24 h and met the baseline trial criteria. Of these, 27 patients (13%) were eligible for DAWN and 39 (19%) for DEFUSE3 and 156 patients were not eligible for DAWN or DEFUSE3 (75%), mainly because there was no perfusion imaging (62%; n = 129). Good outcome was not significantly higher in trial-ineligible (27%) than in trial-eligible (20%) patients (p = 0.343). Patients with large trial-ineligible CT perfusion imaging (CTP) lesions had significantly more hemorrhagic complications (33%) as well as unfavorable outcomes. Conclusion In clinical practice, the high number of patients with a good clinical outcome after endovascular therapy ≥ 6–24 h as in DAWN/DEFUSE3 could not be achieved. Similar outcomes are seen in patients selected for EVT ≥ 6 h based on factors other than CTP. Patients triaged without CTP showed trends for shorter arrival to reperfusion times and higher rates of independence.

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Novel selection paradigms for endovascular stroke treatment in the extended time window

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-325284 ◽

2021 ◽

pp. jnnp-2020-325284

Author(s):

Mehdi Bouslama ◽

Diogo C Haussen ◽

Gabriel Rodrigues ◽

Clara Barreira ◽

Michael Frankel ◽

...

Keyword(s):

Time Window ◽

Ct Perfusion ◽

Clinical Aspects ◽

Anterior Circulation ◽

Stroke Treatment ◽

Good Outcome ◽

Potential Alternative ◽

The Right ◽

Contrast Ct ◽

Selection Methodology

Background and purposeThe optimal selection methodology for stroke thrombectomy beyond 6 hours remains to be established.MethodsReview of a prospectively collected database of thrombectomy patients with anterior circulation strokes, adequate CT perfusion (CTP) maps, National Institute of Health Stroke Scale (NIHSS)≥10 and presenting beyond 6 hours from January 2014 to October 2018. Patients were categorised according to five selection paradigms: DAWN clinical-core mismatch (DAWN-CCM): between age-adjusted NIHSS and CTP core, DEFUSE 3 perfusion imaging mismatch (DEFUSE-3-PIM): between CTP-derived perfusion defect (Tmax >6 s lesion) and ischaemic core volumes and three non-contrast CT Alberta Stroke Program Early CT Score (ASPECTS)-based criteria: age-adjusted clinical-ASPECTS mismatch (aCAM): between age-adjusted NIHSS and ASPECTS, eloquence-adjusted clinical ASPECTS mismatch (eCAM): ASPECTS 6–10 and non-involvement of the right M6 and left M4 areas and standard clinical ASPECTS mismatch (sCAM): ASPECTS 6–10.Results310 patients underwent analysis. DEFUSE-3-PIM had the highest proportion of qualifying patients followed by sCAM, eCAM, aCAM and DAWN-CCM (93.5%, 92.6%, 90.6%, 90% and 84.5%, respectively). Patients meeting aCAM, eCAM, sCAM and DAWN-CCM criteria had higher rates of 90-day good outcome compared with their non-qualifying counterparts(43.2% vs 12%,p=0.002; 42.4% vs 17.4%, p=0.02; 42.4% vs 11.2%, p=0.009; and 43.7% vs 20.5%, p=0.007, respectively). There was no difference between patients meeting DEFUSE-3-PIM criteria versus not(40.8% vs 31.3%,p=0.45). In multivariate analysis, all selection modalities except for DEFUSE-3-PIM were independently associated with 90-day good outcome.ConclusionsASPECTS-based selection paradigms for late presenting and wake-up strokes ET have comparable proportions of qualifying patients and similar 90-day functional outcomes as DAWN-CCM and DEFUSE-3-PIM. They also might lead to better outcome discrimination. These could represent a potential alternative for centres where access to advanced imaging is limited.

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Abstract 3849: The Optimal Target for Thrombolytic Trials: The Interaction of Mismatch Size and IV tPA Treatment in Predicting Good Clinical Outcome

Stroke ◽

10.1161/str.43.suppl_1.a3849 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Alejandro Magadan ◽

Marie Luby ◽

Steven Warach

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Clinical Outcomes ◽

Time Window ◽

Mean Transit Time ◽

Mri Imaging ◽

Good Outcome ◽

Optimal Target ◽

Size Interaction ◽

Iv Tpa

Introduction: Because IV tPA treatment initiated within 4.5 hours is the only acute stroke therapy of proven clinical efficacy, this population offers the greatest validity for determining imaging markers that optimally would differentiate clinical outcomes in treated vs. placebo patients in later time-window clinical trials. The Perfusion Diffusion Mismatch (PDM) approximates the ischemic penumbra, but there is no consensus on the optimal definition or threshold to be used in trials. We assessed the relationship of mismatch size to clinical outcome of an IV tPA treated sample compared with an untreated cohort. Methods: We selected patients from the NINDS Lesion Evolution of Stroke and Ischemia On Neuroimaging (LESION) database who met the following criteria: 1) treated with standard IV tPA 2) received multimodal MRI pre-treatment including diffusion (DWI) and perfusion imaging (PWI), 3) had interpretable MRI imaging showing 4) non-lacunar infarcts or lesions less than 100 ml volumes on DWI and 5) follow-up modified Rankin Score (mRS). We also selected 23 acute stroke patients who did not receive treatment but otherwise met the same criteria. Volumes were measured from the DWI and Mean Transit Time (MTT) images. PDM was defined as either a volume (MTT-DWI) or a percentage (MTT-DWI/MTT). Good outcome was defined as mRS of 0-1. Logistic regression was performed to predict good outcome with covariates of age, initial NIHSS, PDM size, tPA treatment, and tPA treatment by PDM size interaction. Result: Ninety-six patients were treated with IV tPA, 23 patients had no treatment. The figures , showing the unadjusted proportions of patients achieving good outcome as a function of minimum PDM size, suggest greater separation of treated and untreated patients at larger PDM sizes. For percentage PDM a significant interaction of tPA treatment by PDM size was observed at ≥ 80% (p=0.029), indicating that the benefit of tPA treatment is greater for PDM ≥ 80%. For volume PDM, the interaction of tPA treatment by PDM size trended positive at ≥ 50 ml (p=0.058). Conclusion: Greater differences in clinical outcomes with IV tPA versus untreated patients were evident with PDM ≥ 80% or ≥ 50 ml. These minimums of PDM size suggest an optimal target for thrombolytic trials.

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Abstract WMP15: A Simple Tool to Predict Target Mismatch in Ischemic Stroke Patients with Anterior Circulation Occlusion

Stroke ◽

10.1161/str.48.suppl_1.wmp15 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Adam de Havenon ◽

Steve O’Donnell ◽

Alex Linn ◽

Scott McNally ◽

Bailey Dunleavy ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Perfusion Imaging ◽

Time Window ◽

Ct Perfusion ◽

Volumetric Analysis ◽

Stroke Patients ◽

Anterior Circulation ◽

Ct Angiogram

Introduction: The efficacy of endovascular thrombectomy in an extended time window for acute ischemic stroke patients with Target Mismatch (TM) on perfusion imaging was shown in a recent study and the ongoing DEFUSE-3 trial is studying thrombectomy in a 6-16 hour window for TM patients. A limitation of TM is that perfusion imaging is not widely available. We sought to identify a tool to predict TM based on clinical factors and CT angiogram (CTA) imaging, which is available at most hospitals. Methods: We reviewed acute ischemic stroke patients from 2010-2014 with proximal middle cerebral artery occlusion, CTA and CT perfusion (CTP) at hospital admission. TM was identified on CTP using the Olea Sphere volumetric analysis software with Bayesian deconvolution. TM was defined by the DEFUSE-3 criteria. ASPECTS was derived from the non-contrast CT head and the CTA source images (CTA-ASPECTS). Two collateral scores were derived from CTA source images. Results: 61 patients met inclusion criteria. The mean±SD age was 61±18 years and 61% were male. Mean NIH Stroke Scale (NIHSS) was 14.1±8.0 and median (IQR) follow-up modified Rankin Scale was 3 (1,6). TM was present in 35/61 (57%), who had lower mRS at follow-up (z=3.5, p<0.001). The predictor variables are shown in Table 1. The best combination of predictors was CTA-ASPECTS >4 and NIHSS <16, which had a sensitivity of 80% and specificity of 85% for TM (Figure 1). Discussion: We report a reliable, accessible, and clinically useful tool for predicting TM. This score warrants further study as a tool to guide transfer decisions from primary or secondary stroke centers to tertiary centers where endovascular intervention would be possible for selected patients.

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Computed tomography perfusion–based selection of patients for endovascular recanalization

Neurosurgical FOCUS ◽

10.3171/2011.4.focus10296 ◽

2011 ◽

Vol 30 (6) ◽

pp. E6 ◽

Cited By ~ 9

Author(s):

Peter S. Amenta ◽

Muhammad S. Ali ◽

Aaron S. Dumont ◽

L. Fernando Gonzalez ◽

Stavropoula I. Tjoumakaris ◽

...

Keyword(s):

Ct Angiography ◽

Time Window ◽

Ct Perfusion ◽

Imaging Techniques ◽

Endovascular Intervention ◽

Strict Adherence ◽

Endovascular Recanalization ◽

Number Of Patients ◽

Selection Of Patients ◽

Selection Of

Intravenous and intraarterial recombinant tissue plasminogen activator remains underutilized in the treatment of acute ischemic stroke, largely due to strict adherence to the concept of the therapeutic time window for administration. Recent efforts to expand the number of patients eligible for thrombolysis have been mirrored by an evolution in endovascular recanalization technology and techniques. As a result, there is a growing need to establish efficient and reliable means by which to select candidates for endovascular intervention beyond the traditional criteria of time from symptom onset. Perfusion imaging techniques, particularly CT perfusion used in combination with CT angiography, represent an increasingly recognized means by which to identify those patients who stand to benefit most from endovascular recanalization. Additionally, CT perfusion and CT angiography appear to provide sufficient data by which to exclude patients in whom there is little chance of neurological recovery or a substantial risk of postprocedure symptomatic intracranial hemorrhage. The authors review the current literature as it pertains to the limitations of time-based selection of patients for intervention, the increasing utilization of endovascular therapy, and the development of a CT perfusion-based selection of acute stroke patients for endovascular recanalization. Future endeavors must prospectively evaluate the utility and safety of CT perfusion-based selection of candidates for endovascular intervention.

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Abstract TP17: Patients Treated With Endovascular Treatment Outside Guidelines

Stroke ◽

10.1161/str.48.suppl_1.tp17 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Claus Z Simonsen ◽

Mads Rasmussen ◽

Albert J Yoo ◽

Leif H Sørensen

Keyword(s):

Diffusion Weighted Imaging ◽

Time Window ◽

Posterior Circulation ◽

Lesion Volume ◽

Inclusion Criteria ◽

Anterior Circulation ◽

Posterior Circulation Stroke ◽

Good Outcome ◽

Diffusion Weighted ◽

Number Of Patients

Backgroud: The number of Endovascular treatments (EVT) in stroke is increasing rapidly after the publication of the positive trials. Generally, EVT is recommended in anterior circulation large vessel stroke in a 6 hour time window in patients who are independent (modified Rankin scale 2 or less) and if the infarct is not too large (ASPECTS > 4 or diffusion weighted imaging lesion volume <70 cc). Methods: GOLIATH (General Or Local anesthesia in Intra Arterial THerapy) is a study which is testing whether conscious sedation (CS) or general anesthesia (GA) should be recommended during EVT. The inclusion criteria for GOLIATH include those mentioned above and also, patients must have an MRI scan because the primary outcome measure is infarct growth from baseline to 48-72 hours after EVT as measured on diffusion weighted imaging. Included patients are randomized between GA and CS. We have also captured screen failures (i.e., patients who did not fulfil inclusion criteria but who underwent EVT anyway). We compared the number of patients treated in GOLIATH with the number of screen failures from study initiation in March 2015 to August 2016. Results: Eighty-seven patients have been enrolled in GOLIATH. In the same period, 85 patients have been treated with EVT outside of GOLIATH. The reasons for screen failure were: Posterior circulation stroke: 20 patients NIHSS <10: 18 patients Groin puncture > 6 hours: 16 patients CT scan: 16 patients. (Pacemaker, vomiting, metallic foreign bodies or implants) Intubated at arrival: 5 patients Infarct > 70 cc: 3 patients Baseline mRS >2: 2 patients Age <18 years: 2 patients Withdrew consent: 1 patient Deemed unsafe by anesthesiologist: 2 patients Discussion: Among the first 69 patients in GOLIATH, 45 (65%) achieved a good outcome and 6 (9%) were dead at 90 days. Among the first 58 screen failures, 21 (36%) achieved a good outcome and 16 (28%) were dead at 90 days (p=0.002 for good outcome and p=0.01 for death, Chi-square test). Conclusion: A high number of patients are treated outside the general guidelines. Trials are needed to demonstrate effect is these subgroups. (Posterior circulation stroke, NIHSS <10 and groin puncture >6 hours.)

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Abstract TP68: Predictive Value of CT Perfusion in Hyper Acute Ischemic Stroke Patients

Stroke ◽

10.1161/str.51.suppl_1.tp68 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Varun Kumar Pala ◽

Rahul Chandra ◽

Aaron Ravelo ◽

Christopher Hackett ◽

Russell Cerejo

Keyword(s):

Perfusion Imaging ◽

Symptom Onset ◽

Time Window ◽

Ct Perfusion ◽

Infarct Volume ◽

Early Time ◽

Imaging Data ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Core Volume

Introduction: Perfusion imaging has been an integral part in patient selection for Endovascular Thrombectomy (EVT) in the extended window. In studies evaluating perfusion imaging in the early window, the mean time from symptom onset to perfusion imaging was greater than 90 minutes. Objective: To determine the accuracy of perfusion imaging core volume compared to final infarct volume in patients presenting in the hyper acute period. Methods: We performed a retrospective analysis on a prospectively collected stroke data base from January 2018 to July 2019. We included patients with intracranial large vessel occlusion (anterior circulation) who presented within 90 minutes of symptom onset and underwent perfusion imaging with CT-perfusion (CT-P) with subsequent EVT. We collected demographics, clinical and imaging data as well as procedural variables. Final infarct volume on CTH or MRI brain (done> 24hr post EVT) was calculated manually using PACS volume analysis software. RAPID CT-P Software was used for core measurement and CBF<30% was used to predict core. Results: Out of 242 patients who underwent EVT, 22 (9%) patients met inclusion criteria. Of these, 32% (7/22) were males and 68 %( 15/22) were females. Median age was 79 yrs (interquartile range (IQR) 66.7 - 85.2) and median NIHSS was 16 (IQR 14 - 21). M1 occlusion was seen in 59% while, 27% had ICA terminus occlusion and 14% had proximal M2 occlusion. Median core volume pre EVT was 14.5ml (IQR 6.7 - 36.7) and final median infarct volume was 9.6ml (IQR 1.2 - 24.3). Most patients, had final infarct volume calculated on MRI 73 %( 16/22) while 27% (6/22) had follow up CTH. CT- P overestimated the final stroke volume in 55% (12/22 patients) of patients. In a subgroup of 5 patients who presented within 60 minutes of symptoms onset, 80% (4/5 patients) had an over estimated core on CT-P with a median predicted core of 29 ml (IQR 13 - 35) and median final infarct volume of 0.2ml (IQR 0.1 - 3.7). Conclusion: CT-P using CBF < 30% may overestimate the core infarct volume in patients presented in the hyper acute window (<90min). Caution is advised when utilizing CTP in the early time window.

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Simplified selection criteria for patients with longer or unknown time to treatment predict good outcome after mechanical thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014347 ◽

2018 ◽

Vol 11 (6) ◽

pp. 559-562 ◽

Cited By ~ 11

Author(s):

Simon Nagel ◽

Christian Herweh ◽

Johannes Alex Rolf Pfaff ◽

Simon Schieber ◽

Silvia Schönenberger ◽

...

Keyword(s):

Scale Score ◽

Selection Criteria ◽

Mechanical Thrombectomy ◽

Treatment Time ◽

Time Window ◽

Ct Perfusion ◽

Time Windows ◽

Guideline Recommendation ◽

Current Guideline ◽

Good Outcome

ObjectiveTo identify simplified selection criteria for mechanical thrombectomy (MT) in longer and unknown time windows.MethodsPatients with large vessel occlusion (LVO) in the anterior circulation who underwent MT between January 2014 and November 2017 were identified from the local registry. Patients were selected for analysis if they met the current guideline recommendation for MT treatment except for time window (HERMES-like) and were divided according to time they were last seen well (LSW): LSW <6 hours or LSW >6 hours before MT. The primary endpoint, good outcome, was modified Rankin scale score 0–2 on day 90. Safety outcomes were mortality on day 90 and symptomatic intracranial hemorrhage (sICH). Univariate and multivariate analysis were performed for good outcome in HERMES-like patients.ResultsIn total, 752 patients were identified and 390 patients (51.9%) fulfilled the HERMES-like criteria. Despite differences in baseline parameters, more diffusion-weighted imaging (DWI) (43.9% vs 11.3%, p<0.001) and fewer cases of thrombolysis (32.7% vs 77%, p<0.001), patients LSW >6 hours (n=107) did not differ in the primary and secondary endpoints: good outcome (44.9% vs 44.9%, p=1.0), mortality (14% vs 15.2%, p=0.87), and sICH (5.6% vs 6%, p=1.0). After multivariate regression analysis, independent predictors of good outcome remained: age, OR=0.96 (95% CI 0.95 to 0.98); National Institutes of Health Stroke Scale score, OR=0.92 (95% CI 0.89 to 0.96); Alberta Stroke Programme Early CT Score (ASPECTS), OR=1.26 (95% CI 1.06 to 1.49); general anesthesia, OR=0.2 (95% CI 0.04 to 0.99), and successful recanalization, OR=12 (95% CI 4.7 to 30.5); but not treatment time and DWI or CT perfusion at baseline.ConclusionPatients with proven LVO in unknown and longer time windows may be selected for MT based on ASPECTS and clinical criteria.

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Endovascular therapy versus thrombolysis in patients with anterior circulation stroke in everyday clinical practice

International Journal of Stroke ◽

10.1177/1747493016641948 ◽

2016 ◽

Vol 11 (5) ◽

pp. 544-548 ◽

Cited By ~ 7

Author(s):

Andreas Kastrup ◽

Freimuth Brunner ◽

Katrin Wasser ◽

Helmut Hildebrandt ◽

Christoph Roth ◽

...

Keyword(s):

Clinical Practice ◽

Clinical Outcome ◽

Endovascular Treatment ◽

Positive Impact ◽

Intravenous Thrombolysis ◽

Hospital Death ◽

Intracranial Hemorrhages ◽

Everyday Clinical Practice ◽

Good Outcome ◽

The Impact

Background In patients with large vessel occlusions, endovascular treatment has been shown to be superior to intravenous thrombolysis in recent trials. Aims The aim of this study was to analyze the impact of endovascular treatment on clinical and radiological outcome in everyday clinical practice. Methods We compared the rates of good outcome (modified Rankin scale ≤ 2 at discharge), in-hospital death, symptomatic intracranial hemorrhages, and infarct sizes in patients with distal intracranial carotid artery, M1 and M2 occlusions during two time periods. Results From January 2008 to October 2012, a total of 509 patients were treated with intravenous thrombolysis and from November 2012 to December 2014, a total of 270 patients received endovascular treatment with stent retrievers (with or without intravenous thrombolysis). Significantly, more patients in the endovascular treatment group than in the intravenous thrombolysis group had a good outcome (37% vs. 27%, p < 0.01). The infarct sizes were significantly smaller after endovascular treatment than intravenous thrombolysis, whereas the symptomatic intracranial hemorrhages rates and in-hospital mortality were comparable between both treatment groups. The positive impact of endovascular treatment on clinical outcome was most pronounced in patients ≥75 years (31% endovascular treatment vs. 19% intravenous thrombolysis, p < 0.01), in patients with M1 occlusions (43% endovascular treatment vs. 25% intravenous thrombolysis, p < 0.01) and in patients with an admission National Institutes of Health Stroke Scale ≥ 14 (24% endovascular treatment vs. 11% intravenous thrombolysis, p < 0.05). Conclusion In everyday clinical practice and compared with intravenous thrombolysis, endovascular treatment significantly improved clinical outcome and was associated with smaller infarctions. This beneficial effect appeared to be highest in older patients, more severely affected patients, and in those with M1 occlusions.

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Features of the complex treatment of ulcerative colitis in clinical practice

Terapevt (General Physician) ◽

10.33920/med-12-2005-01 ◽

2020 ◽

pp. 6-11

Author(s):

Svetlana Svetlana ◽

Mikhail Klimentov ◽

Olga Neganova ◽

Alina Nazmieva ◽

Anastasiya Kochurova

Keyword(s):

Ulcerative Colitis ◽

Clinical Practice ◽

Statistical Study ◽

Age Groups ◽

Length Of Hospital Stay ◽

Unknown Etiology ◽

Number Of Patients ◽

First Republic ◽

Bowel Diseases ◽

Inflammatory Bowel

Nowadays there are certain difficulties in the early diagnosis of ulcerative colitis, proceeding with minimal intestinal symptoms. The etiology of the disease remains unclear to this day; there is no exact information about the prevalence of the disease due to the large number of latent forms and the low number of patients seeking medical help. This article presents the results of a retrospective analysis of the incidence of ulcerative colitis in the coloproctology department of the First Republic Clinical Hospital of Izhevsk. The study was conducted to assess the frequency of occurrence and determine the internal picture of ulcerative colitis. To achieve this goal, we selected 34 patients with ulcerative colitis. A statistical study was conducted on the following criteria: gender composition, age groups, forms of the disease, localization, complications, and main complaints. The length of hospital stay often was not more than 20 days. The literature on this pathology was also studied and presented in the form of a theoretical basis, which consisted of the determination and etiology of inflammatory bowel diseases. Due to the unknown etiology, insufficiently studied pathogenesis, difficult differential diagnosis with other intestinal diseases and insufficiently perfect treatment methods, there are a large number of unresolved problems in the field of ulcerative colitis. That is why, in this article we tried to reveal the problem of the features of the course and complex therapy of that disease in clinical practice.

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Imaging of Bacteria: Is there Any Hope for the Future Based on Past Experience?

Current Pharmaceutical Design ◽

10.2174/1381612823666171122111558 ◽

2018 ◽

Vol 24 (7) ◽

pp. 772-786 ◽

Cited By ~ 4

Author(s):

Thomas Ebenhan ◽

Elena Lazzeri ◽

Olivier Gheysens

Keyword(s):

Clinical Practice ◽

Sterile Inflammation ◽

Ageing Population ◽

Major Health Problem ◽

Major Health ◽

Number Of Patients ◽

Implanted Medical Devices ◽

Neutropenic Patients ◽

Socio Economic Impact ◽

Made In

Infectious diseases remain a major health problem and cause of death worldwide. It is expected that the socio-economic impact will further intensify due to escalating resistance to antibiotics, an ageing population and an increase in the number of patients under immunosuppressive therapy and implanted medical devices. Even though radiolabeled probes and leukocytes are routinely used in clinical practice, it might still be difficult to distinguish sterile inflammation from inflammation caused by bacteria. Moreover, the majority of these probes are based on the attraction of leukocytes which may be hampered in neutropenic patients. Novel approaches that can be implemented in clinical practice and allow for swift diagnosis of infection by targeting the microorganism directly, are posing an attractive strategy. Here we review the current strategies to directly image bacteria using radionuclides and we provide an overview of the preclinical efforts to develop and validate new approaches. Indeed, significant progress has been made in the past years, but very few radiopharmaceuticals (that were promising in preclinical studies) have made it into clinical practice. We will discuss the challenges that remain to select good candidates for imaging agents targeting bacteria.

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