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Commentary on ‘Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates’
  1. Martin Krupa,
  2. Javier M Romero
  1. Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Javier M Romero, Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA; jmromero{at}

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In their JNIS study, Olive-Gadea et al present a retrospective single-center study demonstrating that inclusion of systematic CT perfusion (CTP) in acute stroke imaging protocols improves the detection of intracranial vessel occlusions and helps to identify additional endovascular treatment (EVT) candidates compared with using CT angiography (CTA) alone.1 Their sample group consisted of 338 consecutive patients with suspected acute ischemic stroke who underwent urgent non-contrast CT, CTA, and CTP. One hundred and fifty-seven (46.5%) patients had hypoperfusion with a Tmax >6 s (RAPID software) in an area congruent with clinical symptoms and were designated as having a vessel occlusion. One hundred and three (30.5%) patients received EVT. Of the 103 patients who received EVT, 31 cases imaged with CTA showed no vessel occlusion, giving a false negative rate of 30.1%. In other words, in this patient group, almost one-third of patients who ultimately received EVT did not have a vessel occlusion identified on their initial CTA scan. These results are congruent with an earlier study by Fasen et al, who reported that up to 20% of occlusions are missed on initial evaluation.2 Since CTA is the workhorse of acute stroke imaging and current American Heart Association/American Stroke Association (AHA/ASA) stroke guidelines strongly support obtaining CTA/MR …

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  • Contributors MK and JMR wrote and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.