ISC 2024 | The ghost core phenomenon using CT perfusion for stroke patient selection

Johanna Ospel, MD, University of Calgary, Calgary, Alberta, Canada, introduces the ‘ghost core’ phenomenon, used to describe the overestimation of infarct core size that can occur when using CT perfusion. In a recent study by Dr Ospel and colleagues, CTP ghost core was shown to occur in ~1 in 10 patients in the ESCAPE-NA1 trial, determined by baseline CTP core volume minus 24-hour infarct volume of over 10ml. Prior to the accumulation of contrary evidence in recent years, CTP was thought to be the optimal method for patient selection for endovascular thrombectomy in the late time window and was used to delineate the irreversibly damaged ischemic core from the salvageable penumbra. However, more and more studies have shown that non-contrast CT alone is sufficient for patient selection and that the overestimation of infarct core using CTP could lead to the exclusion of patients that might benefit from EVT. This interview took place during the International Stroke Conference 2024 in Phoenix, AZ.

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