Background and Purpose: Studies have shown that CT perfusion (CTP) guided endovascular treatment (EVT) increases the rate of favorable outcome in patients with acute ischemic stroke (AIS). The aim of our study is to determine whether we are wasting too much time between noncontrast CT (NCT) imaging completion and CTP completion and the effect it has on clinical outcomes.
Methods: We utilized our endovascular database and analyzed EVT patients. We compared the average time from door to NCT completion with the average time to CTP completion using a paired t-test. Baseline demographics, clinical characteristics, NIH Stroke Scale on admission and discharge, modified Rankin Scale (mRS) at discharge, and presence of intracranial hemorrhage were collected. A linear regression model was created to determine the effect of door time to NCT only completion and time to CTP completion on outcomes.
Results: 288 patients (mean age 71.4 ± 12.8 years; 56.6% females) underwent EVT. 220 patients had EVT after both NCT and CTP and 68 patients underwent treatment right after NCT. There was no difference in baseline demographics and clinical characteristics. (Table 1) The mean completion time for NCT only was 20.0 ±2.8 minutes vs. 75.8 ±152.3 minutes for NCT and CTP (p <.0001). Ninety-day mortality was similar in patients with both NCT and CTP and in patients with only NCT (18.2% versus 20.6%; p=.84). Comparing the CTP patients with the NCT only patients, favorable discharge outcome (mRS 0-2) was observed in 24.1% versus 25.0%, respectively (p=.87). In hospital mortality was observed in 18.6% of CTP and 23.5% of NCT only patients (p=.39).
Conclusions: Our study shows that patients with AIS undergoing EVT take significantly more time for CTP completion with no improvement in outcomes compared to NCT only selected patients. Large prospective studies are further warranted to study CTP use in EVT and to establish and validate the usage of CTP before widespread implementation.