ISC 2023 | Non-contrast CT versus perfusion imaging for treatment decision making in ischemic stroke

Marc Ribo, MD, PhD, Vall d’Hebron University Hospital, Barcelona, Spain, shares his thoughts on the use of advanced imaging in acute ischemic stroke treatment decision making. Accumulating evidence seems to suggest that the use of CT perfusion (CTP) does not provide valuable information beyond what can be discerned from standard non-contrast CT (NCCT), with regards to selecting candidates for endovascular thrombectomy. For example, the recently reported SELECT2 trial (NCT03876457), comparing endovascular therapy to best medical management in patients with large infarct cores, showed that that outcomes were comparable in patients selected with NCCT and CTP, even in the extended time window (up to 24 hours). Dr Ribo notes that there are scenarios in which CTP can be beneficial, such as identifying patients with medium vessel occlusions that may benefit from EVT, but that routine use in LVO cases is not necessary. This interview took place during the International Stroke Conference (ISC) 2023 in Dallas, TX.

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