CT Brain Perfusion Imaging Utilization Following Widening of the Intracranial Mechanical Thrombectomy Treatment Window in a Cosmos Multi-Institutional Population

The goal of this study is to analyze trends in clinical utilization of CT brain perfusion (CTP) across the past 10 years, during which there have been substantial changes in neuro-interventional and neuroimaging guidelines related to emergent stroke therapy, particularly intra-arterial mechanical thrombectomy. The Cosmos platform, a multi-institutional data aggregation tool containing health record data from billions of encounters, was used to retrospectively identify millions of patients with active clinical encounters during the study period (2015–2024). For each calendar quarter, numbers and proportions of active patients undergoing mechanical thrombectomy or brain CTP were obtained using billing code queries. CTP utilization per 100,000 active patients grew slowly from Q1-2015 to Q3-2017, ranging from 4.32 to 9.45, but beginning in Q4-2017, coinciding with the publication of landmark stroke trials, CTP utilization began to increase more rapidly, almost 4-fold higher as determined through segmented linear regression, reaching 61.24 per 100,000 in Q4-2024. Although causation cannot be proven in this study, the observed increases in CTP utilization likely reflect rapid adoption of evidence-based adjustments to stroke triage guidelines after eligibility for mechanical neurointervention had been widened to 24 h from symptom onset.