Abstract P591: A Significant Dose-Response in Elevated Troponin Levels for Case-Fatality Among Patients With Acute Ischemic Stroke

Introduction: About 21% of acute ischemic stroke (AIS) patients present to medical attention with an elevated cardiac troponin (cTn). Previously, we described that elevated cTn is associated with an increased case-fatality at 1 year. However, it is not clear if there is a dose-dependent relationship between cTn and case-fatality, or if this effect is related to causes of death. Methods: Within a catchment area of 1.3 million we screened local hospital admissions using ICD-9/10 codes 430-436/I60-I68, G45-46 in 2014/2015, and ascertained all physician-confirmed AIS cases by retrospective chart review. Positive cTn was defined by the standard 99th percentile. To account for by hospital variance in cTn results in machine brands and normal ranges, cTn values were log-transformed and centered. Case fatality at 1 year and cause of death was obtained from the National Death Index database. Logistic regression evaluated the impact of cTn on case fatality, and included demographic and clinical risk factors in the model. The percentage with all-cause and cardiac/non-cardiac case-fatality was computed by quartiles of centered cTn levels and compared using the chi-square test. Results: In 2014/2015, there were 2989 AIS cases ascertained, which were 53% female, 30% black, with a mean age of 70 (SD 14). 441 patients with hypertropinemia were included in the analysis. See Table for case fatality at 1 year by quartile of centered cTn levels. There was no association between cTN and non-cardiac case-fatality. After adjustment for demographic and clinical characteristics, every 0.5 point increase in the centered cTn level increased the cardiac case-fatality by OR 1.19 (1.09, 1.31), p<0.01. Discussion: We found that the impact of hypertropinemia on case fatality after AIS appears to be a dose-dependent association: as cTn increases, so does the cardiac case-fatality. This suggests that the degree of cTn elevation is likely an important prognostic marker for cardiac death in AIS patients.

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Abstract W MP61: Prevalence of Echocardiographic Abnormalities in Acute Ischemic Stroke

Stroke ◽

10.1161/str.45.suppl_1.wmp61 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Bryan Eckerle ◽

Heidi Sucharew ◽

Kathleen Alwell ◽

Charles J Moomaw ◽

Matthew Flaherty ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Decision Making ◽

Retrospective Chart Review ◽

Clinical Decision ◽

Imaging Method ◽

Chi Square ◽

Exact Test ◽

High Prevalence ◽

Chi Square Test

Introduction: Non-invasive cardiac imaging is an important tool in evaluation of acute ischemic stroke, as a cardiac source can be implicated in approximately 20% of cases. However, the preferred imaging method is unclear due in part to the lack of consistent data regarding the yield of the two most commonly employed modalities, transthoracic and transesophageal echocardiography (TTE and TEE). Here we examine, in a large, biracial population, the prevalence of abnormalities detected by echocardiography during evaluation of acute ischemic stroke. Methods: Acute ischemic stroke cases were identified from a population of 1.3 million in the Greater Cincinnati area in 2005. Medical history and echocardiography results were determined by retrospective chart review. Echocardiographic abnormalities were pre-defined based on possibility of change in clinical decision making. All cases were abstracted by study nurses and subsequently verified by study physicians. Results were stratified by cardiac history and choice of echocardiographic technique; groups were compared using chi-square test or Fisher’s Exact test. Results: There were 2197 hospital-ascertained ischemic stroke cases in 2005. Median age was 73 (IQR 61-81), 22% were black, and 55% were female. TTE was performed in 68% of cases; TEE was performed in 7%. TEE revealed at least one abnormality in 55% of cases with cardiac history and 32% of cases without (Table). Yield of TTE was 20% in cases with cardiac history and 3% in cases without. Discussion: TEE is of considerable yield in selected patients, irrespective of cardiac history. This is in keeping with prior cost-effectiveness analyses recommending TEE alone for patients in whom suspicion of occult source of cardiac embolism is high. Prevalence of abnormalities on TTE in this population is similar to that of previously published series.

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Abstract WP2: Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp2 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kimon Bekelis ◽

Symeon Missios ◽

Todd MacKenzie ◽

Stavropoula Tjoumakaris ◽

Pascal Jabbour

Keyword(s):

New York ◽

Ischemic Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Instrumental Variable ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Case Fatality ◽

Anesthesia Technique ◽

The Impact

Background: The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate, and has not been studied in clinical trials. We investigated the association of general anesthesia with outcomes in patients undergoing mechanical thrombectomy for ischemic stroke. Methods: We performed a cohort study involving patients undergoing mechanical thrombectomy for ischemic stroke from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. An instrumental variable (hospital rate of general anesthesia) analysis was used to simulate the effects of randomization and investigate the association of anesthesia technique with case-fatality and length of stay (LOS). Results: Of the 1,308 patients undergoing mechanical thrombectomy for acute ischemic stroke, 492 (37.6%) underwent general anesthesia, and 816 (62.4%) underwent conscious sedation. Employing an instrumental variable analysis, we identified that general anesthesia was associated with a 6.4% increased case-fatality (95% CI, 1.9% to 11.0%), and 8.4 days longer LOS (95% CI, 2.9 to 14.0) in comparison to conscious sedation. This corresponded to 15 patients needing to be treated with conscious sedation to prevent one death. Our results were robust in a sensitivity analysis utilizing mixed effects regression, and propensity score adjusted regression models. Conclusions: Using a comprehensive all-payer cohort of acute ischemic stroke patients undergoing mechanical thrombectomy in New York State, we identified an association of general anesthesia with increased case fatality and LOS. These considerations should be taken into account when standardizing acute stroke care.

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Abstract WP232: Prevalence of Positive Troponins and Association With Abnormal Echocardiograms in Acute Ischemic Stroke

Stroke ◽

10.1161/str.47.suppl_1.wp232 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Peter Wrigley ◽

Kathleen Alwell ◽

Brian Eckerle ◽

Charles J Moomaw ◽

Felipe De Los Rios La Rosa ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cardiac Disease ◽

Hospital Admissions ◽

Negative Likelihood Ratio ◽

Retrospective Chart Review ◽

High Sensitivity ◽

Prior History ◽

The Us ◽

History Of

Background and Purpose: Acute Ischemic Stroke (AIS) patients may have high sensitivity serum troponin (cTn) levels drawn upon admission, although it is unclear how frequently cTn levels are elevated, and whether these levels are associated with cardiac causes of stroke as seen on echocardiogram. We investigated the prevalence and positivity of cTn and echocardiogram testing within a large biracial population that is representative of the US. Methods: Within a catchment area of 1.3 million we screened local hospital admissions in 2010 using ICD-9 discharge codes 430-436 and ascertained all physician-confirmed AIS cases by standardized retrospective chart review, including diagnostic test results. Any positive cTn was defined by the standard 99 th percentile cutoff. Echocardiogram findings of interest were defined as in the table. Logistic regression was used for analyses, controlling for age, sex, race and prior history of cardiac disease. Results: Of the 1999 AIS cases that presented to an ED in the region 1706 (85.3%) had a cTn drawn and 1590 (79.5%) had an echocardiogram. A positive cTn was seen in 353/1706 (20.7%) and 160/1590 (10%) had an echocardiogram finding of interest. Of the 1377 that had both tests performed, a positive cTn was associated with an abnormal echocardiogram ( adjusted OR 2.9 95% CI 2-4.2 ). A negative cTn did not significantly alter the odds of having an abnormal echocardiogram ( Negative Likelihood Ratio=0.66 ). Conclusion: Testing with serum cTn and echocardiogram was common within our population. Troponinemia above the 99 th percentile was prevalent and was associated with clinically relevant structural cardiac disease on echocardiogram. However absence of troponinemia was not informative regarding the probability of a normal echocardiogram, and therefore does not obviate the need for echocardiography in this at risk population.

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Abstract P402: Blood Pressure Control Poses Significant Delays to Discharge After an Acute Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p402 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Hannah Y Chan ◽

Brian Gulbis ◽

Sean I Savitz ◽

Teresa A Allison

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Length Of Stay ◽

Acute Ischemic Stroke ◽

Pressure Control ◽

Pressure Management ◽

Chi Square ◽

Improvement Project ◽

Blood Pressure Management ◽

The Impact

Acute ischemic stroke (AIS) patients often experience an extended length of stay (LOS) due to multiple factors, including blood pressure management (BPM). The aim of this quality improvement project was to assess the impact of BPM on LOS in AIS patients. This was a retrospective review of 99 AIS patients randomly selected at a comprehensive stroke center from January to June 2020. The primary outcome was the percentage of patients with LOS observed/expected (O/E) ratio ≥ 0.8. Factors associated with delayed hospital discharge (DHD) were evaluated. Chi-square, student t-test, and Mann-Whitney U test were used as appropriate for analysis. Patients had a mean (SD) age of 65 (14) years, median (IQR) NIHSS 7 (4, 15), HTN history (67%), and were African American (40%), Caucasian (32%), or Other (28%). Table 1 shows types of strokes. Twenty-three (23%) patients received tPA. Forty-five (45%) patients had a LOS O/E ratio of ≥ 0.8. Reasons for DHD included BPM (38%), medical management (33%), stroke management (25%), and disposition (4%). Patients with DHD had an initial mean (SD) SBP of 164 (32) mmHg compared to 161 (33) mmHg in patients with no DHD, p=0.603. Figure 1 shows mean SBP trends. Patients with DHD had a median (IQR) of 2 (0, 3) home BP medications compared to 1 (0, 2) in patients with no DHD, p=0.040. Nine patients (20%) with DHD compared to 7 patients (13%) with no DHD were initiated on a nicardipine drip upon admission, p = 0.416. Oral therapy was initiated on median (IQR) hospital day 2.5 (2, 3) in DHD patients vs. 3 (2, 3) in patients with no DHD, p = 0.951. Median (IQR) number of BP medications on discharge was 2 (1, 2) in DHD patients vs. 1 (0, 2) in patients with no DHD, p=0.170. Reasons for elevated BP included delayed therapy initiation (12%), medication titration (59%), and titration intolerability (29%). Blood pressure management in this cohort was one of the most significant factors in delaying discharge. Protocols should focus on better and faster BPM as a means of reducing length of stay.

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The impact of antihypertensive use in the treatment of acute ischemic stroke in patients receiving alteplase

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.07.037 ◽

2021 ◽

Author(s):

Megan A. Rech ◽

Elisabeth Donahey ◽

Joshua M. DeMott ◽

Laura L. Coles ◽

Gary D. Peksa

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

The Impact

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Eosinophil-to-monocyte ratio is a potential biomarker in the prediction of functional outcome among patients with acute ischemic stroke

BMC Neuroscience ◽

10.1186/s12868-021-00610-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shuhong Yu ◽

Yi Luo ◽

Tan Zhang ◽

Chenrong Huang ◽

Yu Fu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Odds Ratio ◽

Poor Outcome ◽

Net Reclassification Improvement ◽

Potential Biomarker ◽

The Impact ◽

The Relationship ◽

Integrated Discrimination Improvement

Abstract Background It has been shown that eosinophils are decreased and monocytes are elevated in patients with acute ischemic stroke (AIS), but the impact of eosinophil-to-monocyte ratio (EMR) on clinical outcomes among AIS patients remains unclear. We aimed to determine the relationship between EMR on admission and 3-month poor functional outcome in AIS patients. Methods A total of 521 consecutive patients admitted to our hospital within 24 h after onset of AIS were prospectively enrolled and categorized in terms of quartiles of EMR on admission between August 2016 and September 2018. The endpoint was the poor outcome defined as modified Rankin Scale score of 3 to 6 at month 3 after admission. Results As EMR decreased, the risk of poor outcome increased (p < 0.001). Logistic regression analysis revealed that EMR was independently associated with poor outcome after adjusting potential confounders (odds ratio, 0.09; 95% CI 0.03–0.34; p = 0.0003), which is consistent with the result of EMR (quartile) as a categorical variable (odds ratio, 0.23; 95% CI 0.10–0.52; ptrend < 0.0001). A non-linear relationship was detected between EMR and poor outcome, whose point was 0.28. Subgroup analyses further confirmed these associations. The addition of EMR to conventional risk factors improved the predictive power for poor outcome (net reclassification improvement: 2.61%, p = 0.382; integrated discrimination improvement: 2.41%, p < 0.001). Conclusions EMR on admission was independently correlated with poor outcome in AIS patients, suggesting that EMR may be a potential prognostic biomarker for AIS.

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Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Cerebrovascular Diseases ◽

10.1159/000445299 ◽

2016 ◽

Vol 42 (1-2) ◽

pp. 81-89 ◽

Cited By ~ 28

Author(s):

Mohamed Al-Khaled ◽

Christine Matthis ◽

Andreas Binder ◽

Jonas Mudter ◽

Joern Schattschneider ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Case Fatality ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Stroke Outcomes ◽

Increased Risk ◽

Reduced Risk

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

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Impact of Post-Stroke Recanalization on General and Upper Limb Functioning: A Prospective, Observational Study

Neurology International ◽

10.3390/neurolint13010005 ◽

2021 ◽

Vol 13 (1) ◽

pp. 46-58

Author(s):

João Paulo Branco ◽

Filipa Rocha ◽

João Sargento-Freitas ◽

Gustavo C. Santo ◽

António Freire ◽

...

Keyword(s):

Ischemic Stroke ◽

Observational Study ◽

Acute Ischemic Stroke ◽

Upper Limb ◽

Functional Recovery ◽

Prospective Observational Study ◽

Positive Impact ◽

Rehabilitation Program ◽

Patient Functioning ◽

The Impact

The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery.

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Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽

10.1161/str.52.suppl_1.p119 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nicolle W Davis ◽

Meghan Bailey ◽

Natalie Buchwald ◽

Amreen Farooqui ◽

Anna Khanna

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Patient Outcomes ◽

Time Of Day ◽

Stroke Patients ◽

Acute Stroke Care ◽

The Impact ◽

Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

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Abstract 1122‐000034: Systematic CT‐Perfusion acquisition in All Suspected Stroke Patients Increases Vascular Occlusion Detection and Thrombectomy Rates

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000034 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Marta Olive‐Gadea ◽

Manuel Requena ◽

Facundo Diaz ◽

Alvaro Garcia‐Tornel ◽

Marta Rubiera ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Symptoms ◽

Ct Perfusion ◽

False Negative ◽

False Negative Rate ◽

Vascular Occlusion ◽

Stroke Patients ◽

Imaging Protocols ◽

The Impact

Introduction : In acute ischemic stroke patients, current guidelines recommend noninvasive vascular imaging to identify intracranial vessel occlusions (VO) that may benefit from endovascular treatment (EVT). However, VO can be missed in CT angiography (CTA) readings. We aim to evaluate the impact of consistently including CT perfusion (CTP) in admission stroke imaging protocols on VO diagnosis and EVT rates. Methods : We included patients with a suspected acute ischemic stroke that underwent urgent non‐contrast CT, CTA and CTP from April to October 2020. Hypoperfusion areas defined by Tmax>6s delay (RAPID software), congruent with the clinical symptoms and a vascular territory, were considered due to a VO (CTP‐VO). Cases in which mechanical thrombectomy was performed were defined as therapeutically relevant VO (EVT‐VO). For patients that received EVT, site of VO according to digital subtraction angiography was recorded. Two experienced neuroradiologists blinded to CTP but not to clinical symptoms, retrospectively evaluated NCCT and CTA to identify intracranial VO (CTA‐VO). We analyzed CTA‐VO sensitivity and specificity at detecting CTP‐VO and EVT‐VO respecitvely. We performed a logistic regression to test the association of Tmax>6s volumes with CTA‐VO identification and indication of EVT. Results : Of the 338 patients included in the analysis, 157 (46.5%) presented a CTP‐VO, (median Tmax>6s: 73 [29‐127] ml). CTA‐VO was identified in 83 (24.5%) of the cases. Overall CTA‐VO sensitivity for the detection of CTP‐VO was 50.3% and specificity was 97.8%. Higher hypoperfusion volume was associated with an increased CTA‐VO detection, with an odds ratio of 1.03 (95% confidence interval 1.02‐1.04) (figure). DSA was indicated in 107 patients; in 4 of them no EVT was attempted due to recanalization or a too distal VO in the first angiographic run. EVT was performed in 103 patients (30.5%. Tmax>6s: 102 [63‐160] ml), representing 65.6% of all CTP‐VO. Overall CTA‐VO sensitivity for the detection of EVT‐VO was 69.9%. The CTA‐VO sensitivity for detecting patients with indication of EVT according to clinical guidelines was as follows: 91.7% for ICA occlusions and 84.4% for M1‐MCA occlusions. For all other occlusion sites that received EVT, the CTA‐VO sensitivity was 36.1%. The overall specificity was 95.3%. Among patients who received EVT, CTA‐VO was not detected in 31 cases, resulting in a false negative rate of 30.1%. False negative CTA‐VO cases had lower Tmax>6s volumes (69[46‐99.5] vs 126[84‐169.5]ml, p<0.001) and lower NIHSS (13[8.5‐16] vs 17[14‐21], p<0.001). Conclusions : Systematically including CTP perfusion in the acute stroke admission imaging protocols may increase the diagnosis of VO and rate of EVT.

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