Abstract:

Acute ischemic stroke (AIS) is one of the most common and severe neurological 
emergencies, characterized by the sudden interruption of cerebral blood flow and rapidly ensuing 
neuronal damage. Early differentiation between the infarct core and the penumbra is crucial for 
selecting an appropriate therapeutic strategy. CT brain perfusion has emerged as a highly sensitive 
method for evaluating tissue viability and identifying potentially salvageable brain parenchyma in 
patients with acute AIS. The aim of the present study is to assess the significance of CT perfusion in 
decision-making for thrombolytic therapy in patients with acute neurological symptoms and a 
confirmed ischemic lesion. The methodology includes an analysis of patients who underwent CT 
brain perfusion at MHAT “Heart and Brain” – Burgas in 2025 and subsequently received 
intravenous thrombolytic treatment. Follow-up imaging results were evaluated to determine 
therapeutic effectiveness and the presence of complications. The obtained results demonstrate 
significantly lower complication rates, reduced mortality, and improved functional outcomes in 
patients with early symptom onset and timely imaging assessment. The conclusion supports the 
pivotal role of CT perfusion in selecting patients for thrombolysis, enabling an individualized 
approach and increasing the likelihood of preserving viable brain tissue. 

Keywords: AIS, CT perfusion, imaging diagnostics, brain viability, thrombolysis.

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