What is your preferred imaging modality for determining infarct core when evaluating acute stroke cases?  

MRI is the best imaging modality for determining core infarct, but non-contrast head CT and CT perfusion imaging are more practical and faster, so they are used by a vast majority of centers. I use CT and CTP because they are much faster to obtain at my institutions.

Here is my simplified algorithm I use in most cases for deciding on both TNK and thrombectomy. First line is CT and CTA head and neck, looking at ASPECTS and collateral flow. If both favorable and within 4.5h for TNK and 6h for thrombectomy, proceed with treatment. If presenting beyond 6h, I add CT...