Anterior circulation large vessel occlusion (LVO) patients undergoing MDCTP and CBCTP were prospectively enrolled in a single arm interventional study. CBCTP images were acquired on an Artis Zee biplane system. CBCTP projection datasets were post-processed independently using a RAPID prototype. Core infarct was defined as CBF<45% in CBCTP images. Intraclass correlation coefficient (ICC) and Pearson (r) correlation were used for comparisons, and Bland-Altman analysis for agreement. Sensitivity analysis was also performed to evaluate the association between CBCTP images and the final infarct volume (FIV) on post-MT DWI-MRI sequences for patients with mTICI 2b-3.

Thirteen patients were included (male: 46%; median age 80 years, median NIHSS 19, LKW to groin puncture time:  302 minutes, MDCTP to CBCTP time: 47 minutes). Twelve patients underwent MT (one had spontaneous recanalization). Successful reperfusion was achieved in 10/12. There were no significant differences in median volumes of CBF (12ml IQR 7-50 vs 21.6ml IQR 0-91), Tmax>6s (184ml IQR 121-212 vs. 151ml IQR 76-192), and Tmax>10s (88ml IQR 40-133 vs. 71ml IQR 37-98) between MDCTP and CBCTP, respectively. We found an ICC of 0.89, 0.74, and 0.92 for CBF, Tmax>6s, and Tmax>10s, respectively. MDCTP correlated with CBCTP in CBF (r=0.91), Tmax>6s (r=0.74), and Tmax>10s (r=0.92). Bland-Altman analysis showed 92% agreement for CBF and Tmax>6s, and 100% for Tmax>10s. Sensitivity analysis showed good correlation (r=0.87, ρ=0.87) and ICC of 0.81 between FIV and CBCTP images.

Our results demonstrate a promising accuracy of CBCTP in evaluating infarct ischemic tissue in patients with LVO eligible for MT.