CT perfusion-guided versus time-guided mechanical recanalization in acute ischemic stroke patients

Abstract Objective Perfusion studies are increasingly used to triage acute stroke patients for endovascular recanalization therapies. We compare the safety and efficacy of CT perfusion (CTP)-guided to time-guided mechanical recanalization in acute ischemic stroke (AIS) patients. Methods A review was conducted on 132 patients, 94 undergoing CTP-guided and 38 undergoing time-guided (maximum 8 h from symptom onset) mechanical recanalization at our institution. Results The rate of partial-to-complete recanalization did not differ between the CTP and the non-CTP group (78.7% vs. 81.6%, respectively, p = 0.71). ICH occurred respectively in 18.1% in the CTP group versus 31.6% in the non-CTP group ( p = 0.06). The overall in-hospital mortality rate was significantly lower in the CTP group (15.9% vs. 36.8%, p = 0.04). In multivariable analysis, CTP-guided patient selection was an independent negative predictor of in-hospital mortality (OR = 3.2; p = 0.01). CTP-guided patient selection, however, was not a predictor of favorable outcome (Modified Rankin Scale 0–2 or 0–3). Conclusions CTP-based patient selection was associated with lower ICH and mortality rates. Favorable outcomes, however, did not differ between the 2 groups. These results may suggest a possible benefit in terms of in-hospital mortality with CTP-guided triage of AIS patients for endovascular treatment.