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Stroke remains a significant global health concern, necessitating precise and efficient diagnostic tools for timely intervention and improved patient outcomes. The emergence of deep learning methodologies has transformed the landscape of medical image analysis. Recently, Transformers, initially designed for natural language processing, have exhibited remarkable capabilities in various computer vision applications, including medical image analysis. This comprehensive review aims to provide an in-depth exploration of the cutting-edge Transformer-based architectures applied in the context of stroke segmentation. It commences with an exploration of stroke pathology, imaging modalities, and the challenges associated with accurate diagnosis and segmentation. Subsequently, the review delves into the fundamental ideas of Transformers, offering detailed insights into their architectural intricacies and the underlying mechanisms that empower them to effectively capture complex spatial information within medical images. The existing literature is systematically categorized and analyzed, discussing various approaches that leverage Transformers for stroke segmentation. A critical assessment is provided, highlighting the strengths and limitations of these methods, including considerations of performance and computational efficiency. Additionally, this review explores potential avenues for future research and development

Stroke segmentation plays a crucial role in the diagnosis and treatment of stroke patients by providing spatial information about affected brain regions and the extent of damage. Segmenting stroke lesions accurately is a challenging task, given that conventional manual techniques are time consuming and prone to errors. Recently, advanced deep models have been introduced for general medical image segmentation, demonstrating promising results that surpass many state of the art networks when evaluated on specific datasets. With the advent of the vision Transformers, several models have been introduced based on them, while others have aimed to design better modules based on traditional convolutional layers to extract long-range dependencies like Transformers. The question of whether such high-level designs are necessary for all segmentation cases to achieve the best results remains unanswered. In this study, we selected four types of deep models that were recently proposed and evaluated their performance for stroke segmentation: a pure Transformer-based architecture (DAE-Former), two advanced CNN-based models (LKA and DLKA) with attention mechanisms in their design, an advanced hybrid model that incorporates CNNs with Transformers (FCT), and the well-known self-adaptive nnUNet framework with its configuration based on given data. We examined their performance on two publicly available datasets, and found that the nnUNet achieved the best results with the simplest design among all. Revealing the robustness issue of Transformers to such variabilities serves as a potential reason for their weaker performance. Furthermore, nnUNet's success underscores the significant impact of preprocessing and postprocessing techniques in enhancing segmentation results, surpassing the focus solely on architectural designs