I would say no, until we prove that perfusion imaging helps risk stratify patients with symptomatic ICAD and select them for reperfusion therapies.

I agree with Dr. Yaghi that not all patients should undergo perfusion studies. In vascular neurology, few things (if anything) are one size fits all. There are no set guidelines regarding this subject since it is an understudy population but some physicians get perfusion studies on symptomatic foca...

Very interesting question for sure. First, sometimes it is hard to tell in the acute setting if there is chronic severe stenosis or acute occlusion, in this setting for sure CTP will help showing more tmax < 4 (more benign oligemia) with tmax >4/tmax > 6 equal or more than 2. And for me, ...

To my knowledge, there is no evidence that CTP can reliably guide decisions in a way that impacts meaningful patient outcomes and therefore, does not justify the significant radiation dose (3.5 to 7.5x an NCCT). Zensen et al., PMID 32901338