RT Journal Article SR Electronic T1 Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 1270 OP 1273 DO 10.1136/neurintsurg-2021-018241 VO 14 IS 12 A1 Marta Olive-Gadea A1 Manuel Requena A1 Facundo Diaz A1 Sandra Boned A1 Alvaro Garcia-Tornel A1 Marian Muchada A1 Matias Deck A1 Prudencio Lozano A1 Noelia Rodriguez-Villatoro A1 Jesus Juega A1 Jorge Pagola A1 David Rodriguez-Luna A1 Marta Rubiera A1 Cristian Marti A1 Carlos A Molina A1 Carlos Piñana A1 David Hernandez A1 Alejandro Tomasello A1 Marc Ribo YR 2022 UL http://jnis.bmj.com/content/14/12/1270.abstract AB Background In patients with stroke, current guidelines recommend non-invasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols.Methods From April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT, CTA and CTP and were treated accordingly. Hypoperfusion areas defined by time-to-maximum of the tissue residue function (Tmax) >6 s, congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated non-contrast CT and CTA to identify intracranial VO (CTA-VO).Results Of the 338 patients included in the analysis, 157 (46.5%) presented with CTP-VO (median Tmax >6s: 73 (29–127) mL). CTA-VO was identified in 83 (24.5%) of the cases. Overall CTA-VO sensitivity for the detection of CTP-VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with increased CTA-VO detection (OR 1.03; 95% CI 1.02 to 1.04). EVT was performed in 103 patients (30.5%; Tmax >6s: 102 (63–160) mL), representing 65.6% of all CTP-VO. Overall CTA-VO sensitivity for the detection of EVT-VO was 69.9% and specificity was 95.3%. Among patients who received EVT, the rate of false negative CTA-VO was 30.1% (Tmax >6s: 69 (46–99.5) mL).Conclusion Systematically including CTP in acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.Data are available upon reasonable request. Not applicable.