ABSTRACT NUMBER: ESOC2026A59 ULTRA-EARLY CT PERFUSION–GUIDED DECISION-MAKING IN ACUTE ISCHAEMIC STROKE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Ultra-early stroke assessment aims to reduce treatment delays, yet the comparative effectiveness of computed tomography perfusion (CTP) versus standard non-contrast CT (NCCT) remains uncertain. This meta-analysis synthesised evidence on whether CTP-based triage improves clinical and workflow outcomes in hyperacute ischaemic stroke. Methods A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library identified studies comparing CTP-guided and NCCT-guided pathways for patients presenting within 6 hours of onset. Outcomes included door-to-needle time, door-to-puncture time, reperfusion eligibility, functional independence (modified Rankin Scale ≤2), symptomatic intracranial haemorrhage, and mortality. Random-effects models generated pooled mean differences (MD) and odds ratios (OR). Results Fourteen studies (n = 18,942) were included. CTP significantly increased eligibility for reperfusion therapies (OR: 1.42, 95% CI: 1.19–1.68, p < 0.001; I2 = 49%). Door-to-needle time decreased modestly (MD: −5.9 min, 95% CI: −9.7 to −2.1, p = 0.002; I2 = 72%). Functional independence improved (OR: 1.23, 95% CI: 1.08–1.41, p = 0.003; I2 = 31%). No differences were observed for symptomatic intracranial haemorrhage (OR: 0.93, 95% CI: 0.74–1.17; p = 0.54) or mortality (OR: 0.96; p = 0.67). Conclusions CTP-based triage enhances reperfusion eligibility and functional outcomes without increasing complications. These findings support broader integration of CTP into hyperacute stroke pathways, particularly in high-volume centres. Conflict of interest all authors have has nothing to disclose