Low signal, high noise and large uncertainty make CT perfusion unsuitable for acute ischemic stroke patient selection for endovascular therapy

摘要

INTRODUCTION: I WAS WRONG Neurointerventionists are on the cusp of revolutionizing the care of the acute ischemic stroke patient. The stage is set for a major advance after 2 decades of experience and the development of extraordinarily effective endovascular devices. This advance depends on a clear demonstration of improved patient outcomes, but the evidence for improved outcomes after endovascular therapy is weak. This was most dramatically demonstrated by the halting of the IMS III trial (ClinicalTrials.gov Identifier: NCT00359424). There is an emerging consensus that the proper selection of patients for endovascular treatment has been lacking. Patient selection using neuroimaging has not been successful, most likely because ineffective neuroimaging methods have been employed.