Objective Advanced Neuroimaging has been proving to be pivotal in acute ischemic stroke management. CT Perfusion (CTP) core and penumbra parameters have not yet been investigated to predict the outcome in Wake-up Stroke (WUS) patients in everyday clinical scenario. The aim of our study is to investigate the predictive power of CTP-parameters on functional and morphological outcomes in rTPA treated WUS patients. Approach We analyzed clinical data and processed CTP images of 80 consecutive WUS rTPA treated patients. The predictive power of wholebrain CTP features and of the clinical stroke related parameters to predict NIHSS at 7th day and Ischemic Lesion Volume outcome was investigated by means of multivariate regression analysis as well as LASSO modeling. Main results Multivariate analysis showed that CTP core volume (β: 0.403, p= 0.000), NIHSS at admission (β: 0.323, p= 0.005) and ASPECTS (β: -0.224, p= 0.012) predict NIHSS at 7-days, while total hypoperfused volume (β: 0.542, p= 0.000) and core volume on CTP (β: 0.441, p= 0.000) predict infarct lesion volume at follow-up CT. The LASSO modeling approach confirmed the significant predictive power of CTP core volume, CTP total hypoperfused, NIHSS at baseline and ASPECTS producing a sparse model with adequate reliability (RMSE on previously unseen testing dataset was 3.68). Significance Our findings highlight the importance of CT multimodal imaging features in the decision-making and predictivity in the hyperacute phase of WUS. The predictive model supports the hypothesis that irreversible necrotic core rather the extent of penumbra is the main prognostic determinant in rTPA treated WUS patients.