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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 …
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.
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