Rethinking the role of CT perfusion in the management of emergent large vessel ischemic stroke

The treatment of emergent large vessel occlusion (ELVO) was revolutionized by endovascular thrombectomy (EVT). The identification of eligible patients for EVT has sparked significant interest in determining the neuroimaging modality that offers optimal results. The American Stroke Association recommend the use of both non-contrast CT and CT angiogram for patients coming in the early window (0–6 hours).1 In the late window (6–24 hours) the randomized trials, DAWN and DEFUSE 3, showed clinical benefit utilized some form of quantitative estimation of the core infarct.2 3 Consequently the society recommends automated perfusion CT neuroimaging in addition to non-contrast CT and CT angiogram when dealing with patients presenting in the late window (6–24 hours). Having quantitative estimates would help neurointerventionalists identify patients who already have a large core and small penumbra—factors that may be associated with procedural futility and/or symptomatic hemorrhagic transformation. Perfusion imaging is not the only way...
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Editor ' s column Source Type: research