Role of Radiology in the Cardiovascular and Neurological Investigation of Ischemic Stroke

Ischemic stroke (IS) is a time-dependent neurological emergency in which imaging methods play a fundamental role from initial diagnosis through etiological investigation and secondary prevention. The aim of this review was to analyze the contribution of neuroimaging, vascular assessment, and cardiovascular imaging to the management of ischemic stroke. This is a descriptive and analytical systematic literature review conducted according to the PRISMA 2020 recommendations. PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, BVS, and SciELO were searched, prioritizing publications from 2021 to 2026. The results showed that non-contrast computed tomography remains the main initial method for excluding hemorrhage and assessing early ischemic changes, whereas CT angiography plays a decisive role in identifying large-vessel occlusions and planning thrombectomy. CT perfusion and magnetic resonance imaging expand the assessment of the ischemic core, penumbra, and tissue viability, particularly in late therapeutic windows or when onset time is unknown. In cardiovascular investigation, echocardiography remains central and is complemented by cardiac computed tomography and magnetic resonance imaging for identifying intracardiac thrombi, cardiomyopathies, interatrial septal abnormalities, and aortic sources of embolism. It is concluded that the ideal approach should be multimodal and individualized, integrating cerebral, vascular, and cardiovascular findings. Rational and sequential use of imaging methods can optimize reperfusion, improve etiological accuracy, and guide secondary prevention strategies in ischemic stroke.