Background Recently, perfusion imaging has been utilised to provide visualization of at risk ischemic tissue that would benefit from revascularization treatment; however, current research differs in recommendations on the use of perfusion. The purpose of our study was to evaluate whether perfusion imaging helped guide diagnosis and treatment of ischemic strokes. Methods and materials We conducted a retrospective review for patients who received perfusion imaging and/or treatment for ischemic stroke over a three-year period. We reviewed the progression of diagnosis, treatment or lack of, complications of treatment, and whether the imaging played a role in the treatment plan. Results The majority of patients in this study had treatment that was influenced by perfusion imaging. This was most evident in our population of patients that received intra-arterial therapy as 95% of these patients received treatment based on the results of imaging. There was an impact in the decision to not treat patients who had completed strokes on perfusion imaging, preventing unnecessary treatment and complications. In addition, our perfusion imaged patients were found to have a significantly longer time to treat than those that did not receive imaging, extending beyond the three-hour treatment window with an average of 4.88 h without an increased risk of complications or decrease in clinical outcome. Conclusion Perfusion imaging can be used in the real world setting as a tool to guide patient diagnosis and treatment, to select patients with salvageable tissue to receive intra-arterial treatment outside the standard intravenous time window. Disclosures K. Seifert: None. J. Wiener: None. D. DeOrchis: None.

This case report details a technique to intraoperatively define a segment of small bowel containing a bleeding arteriovenous malformation allowing definitive surgery. A patient with an arteriovenous malformation of the small intestine underwent angiographic localization using a highly selective microcatheter and intraoperative methylene blue dye allowing a specific segment of intestine to be resected. Angiographic identification and intraoperative location of small intestine arteriovenous malformations can allow the surgeon to more accurately define the affected segment allowing the surgery to be specific and successful.