Abstract 286: Impact of Reducing CTP Use on Stroke Workflow and Outcomes in a Large Health System

Background Time to treatment is critical in acute ischemic stroke. While CT perfusion (CTP) imaging is guideline‐recommended for patients with large vessel occlusion (LVO) for endovascular thrombectomy (EVT) in the extended treatment window, its widespread use outside these criteria may delay reperfusion. Historically, our health system performed CTP in nearly all stroke codes. However, with the emergence of trials demonstrating EVT benefit in large‐core infarcts, we transitioned in December 2023 to a predominantly ASPECTS‐based approach for IV thrombolysis (IVT) and EVT, reserving CTP for complex cases. Methods We retrospectively reviewed all patients treated with IVT or EVT across our health system from January 2023 to May 2025. Patients were stratified by CTP use. Primary workflow outcomes included door to needle (DTN) and door‐to‐puncture (DTP) times. Clinical outcomes included discharge and 90‐day modified Rankin Scale (mRS), and hemorrhagic conversion, and death. Results 320 patients were identified and detailed in table 1. Using an ASPECTS‐only approach reduced the mean DTN time by 19 minutes (95% CI 9.0‐29.8 minutes saved, p<0.001) and DTP time by 21 minutes (95% CI 8.2‐33.2 minutes saved, p<0.001). Although the proportion of patients with favorable 90‐day mRS (0‐2) was 9.9% higher in the ASPECTS‐only group, this was not statistically significant (OR=0.67, 95% CI 0.34‐1.34, p=0.26). Hemorrhagic conversion rates were similar between groups (p=0.22). 90 day mortality dropped by 50% (p=0.036) which may reflect treatment era effects or operator variability rather than imaging strategy itself. Conclusion Reducing CTP use in acute stroke codes streamlined workflows and significantly shortened treatment times. Overall, our findings support SVIN guidelines favoring ASPECTS‐based evaluation for EVT. Our study was limited by its retrospective design, and low 90‐day mRS response. Larger studies are warranted to further assess the clinical impact of reduced CTP utilization in acute stroke care. image image