ISC 2024 | Debating the use of CT perfusion for detection of medium vessel occlusions

Johanna Ospel, MD, University of Calgary, Calgary, Alberta, Canada, discusses current uncertainties in the management of acute ischemic stroke due to medium vessel occlusion (MeVOs), namely optimal detection and treatment strategies. MeVOs (M2/3, A2/3, and P2/3 segment occlusions) are smaller and more distal than large vessel occlusions, making detection more difficult. Therefore, the need for advanced imaging for MeVO detection is a key talking point in the field currently. While CT perfusion (CTP) offers clear visibility of MeVOs, its availability is limited. Other techniques, including multiphase CT angiography (CTA) can also be used in this setting. Dr Ospel argues that a faster, more accessible imaging technique is more important than one that gives the highest quality images given the urgency of stroke treatment. Ongoing randomized, clinical trials assessing the use of endovascular therapy in MeVOs should help to answer the question of which imaging paradigm should be used, with some trials employing CTP and others using multiphase or single-phase CTA. This interview took place during the International Stroke Conference 2024 in Phoenix, AZ.

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