Can we Always Rely on Computed Tomography Perfusion Imaging When Selecting Stroke Patients for Thrombectomy?

The use of computed tomography perfusion (CTP), one of the multimodal imaging uncorrected proof modalities, has recently become an important tool in determining endovascular treatment candidates in stroke centers. However, the reliability of CTP in identifying the infarct core may vary depending on the time of symptom onset, collateral status, and other clinical factors. In some studies, it has been determined that showing the penumbra with CTP imaging increases the chance of success in the selection of patients for endovascular treatment. The difference in sensitivity to hypoxia in the brain parenchyma (such as white and gray matter) makes it difficult to determine the ischemic tissue response, thus increasing the importance of perfusion studies. Accordingly, many automatic software programs have been used with CTP imaging. Among these, RAPID (iSchemaView, Menlo Park, California, USA) and Olea Sphere (Olea Medical Solutions, La Ciotat, France) are among the most frequently used. The rates of each of these programs showing the infarct core and the probability of error have been discussed by different studies. In this article, we aim to evaluate the role of CTP imaging in the treatment process before deciding on whether to deliver endovascular treatment for a 55-year-old female patient who presented with right-middle cerebral artery infarction clinic and had a wake-up stroke.