• CT
• Stroke

‘If you wish to converse with me,’ said Voltaire, ‘define your terms.’ How many a debate would have been deflated into a paragraph if the disputants had dared to define their terms! — Will Durant.1

We love debates. They are entertaining. They sharpen and clarify viewpoints but they could bypass the thought processes behind them. Very often, differences in opinion can be explained by different assumptions and expectations based on available resources. Moreover, those involved in the debate may not be fully aware of their own assumptions and biases often defending the situation in the home institution. One typical example is the debate about whether or not to use computed tomography perfusion (CTP) in patient selection for thrombectomy in acute ischemic stroke patients. The key issue is ‘patient selection’. One might think there should be one correct answer based on the highest level evidence. But this is not true.

CTP is mainly beneficial for increasing sensitivity in detecting acute perfusion abnormalities and for broadening the spectrum of mechanical thrombectomy (MT) patients. Most data we are currently seeing originate from MT registries that are focused mainly on emergent large vessel occlusion (ELVO) patients already identified successfully by diagnostic imaging processes. This data does not represent the variety of patients with the suspected stroke and allows for limited conclusions on the additional benefit of CTP beyond the current typical indications, such as in the …