CT perfusion in acute ischemic stroke: Optimizing image-based patient selection for endovascular treatment

CT perfusion could help to obtain additional information on the perfusion status of the brain in patients with acute ischemic stroke. Even though CTP is increasingly used in acute stroke care, its added value is largely unknown. The primary goal of this thesis was to gain more insight into the diagnostic, prognostic, and health-economic value of CTP.
Part I described the volumetric and spatial accuracy of CT ischemic core estimations from two perfusion post-processing software packages, RAPID and syngo.via.
In Part II, we focused on the prognostic and clinical added value of CTP imaging. We found that CTP-estimated ischemic core volume was associated with poor outcome. In addition, we found that infarct growth is not affected by intravenous alteplase administered prior to EVT within 4.5h after symptom onset. Also, we found that the extent of the CTP-estimated hypoperfusion does not alter the treatment effect of intravenous alteplase prior to EVT.
Part III of this thesis shows the results on the cost-effectiveness of CT perfusion imaging. We demonstrated that excluding patients within six hours after symptom onset from endovascular treatment based on CTP parameters is not cost-effective.
CTP has the potential to aid the diagnostic workup of patients with acute ischemic stroke, but CTP results should be interpreted cautiously. Further exploring the clinical utility of CTP in acute ischemic stroke can help to refine and optimize its use, ultimately improving the care and clinical outcomes of stroke patients.