Do you recommend CT perfusion in patients presenting with symptoms of acute stroke before 6 hours?

Routine CTP is not required in the <6 hours according to the AHA/ASA guidelines. The TENSION large core data would also support not requiring CTP in the early window.

In the >6-24 hour period, the MR CLEAN-LATE trial, which was based on patients with CTA collaterals selection, showed favorable outcom...

I don't routinely obtain CTP if a patient with a large vessel occlusion presents within 6 hours of the last known well. For me, the ASPECTS score on CT head and vessel occlusion confirmation on CTA head/neck is enough to proceed with intervention in this time frame (it would be rare not to proceed o...

For isolated aphasia, I will use this modality if it has been <6 hours since symptom onset to avoid missing a left MCA trifurcation occlusion at the origin of a branch (especially if no prior CTA to compare to). Otherwise, I think it's important to keep in mind the phenomenon of "ghost core".

Rotem e...

I personally still find the CTP useful, based on the few patients who already have large established infarctions despite the short time horizon. If there is any delay, I would go ahead with the mechanical thrombectomy without it.

It is a very interesting question; although I agree with Dr. @Dr. First Last that according to AHA/ASA, CTP is not required within the <6 hours window, though it does provide valuable information about collateral flow and prognosis.

I have seen that a very large core, even within 6 hours, often corr...

Not routinely, it delays TNK and thrombectomy. I get a CTP if the collaterals in the suspected infarct territory are poor or questionable. Patients that present very early from symptom onset (less than an hour) can have an ASPECTS of 10 but with terrible collaterals, that brain has often already inf...

AHA guidelines do not recommend it and with the large core trial data now for ICA and M1, many centers even beyond 6 hours do not obtain it, regardless of the core.

It also depends on the patient. For M2 or proximal M3, occlusions in patients whose deficits improve or have a low NIHSS, but for a disa...