A cute stroke treatment has dramatically changed in the past decade. Boundaries are crossed, and previous axioms are no longer relevant. The results of the DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo (DAWN) and Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3 (DEFUSE-3) trials, 1,2 examining endovascular thrombectomy (EVT) in the late timeframe (6-24 hours from stroke onset), have thrust perfusion imaging into the evaluation of acute stroke protocol. 3 The primary purpose of CTP is to distinguish salvageable tissue from infarct core and thus improve patient selection for EVT. [3][4][5] It is now widely used as part of an acute stroke CT protocol. However, many stroke centers worldwide routinely perform CTP only for patients beyond the early timeframe. This is in accordance with the recent acute stroke guidelines, recommending CTP in the late (6-24 hour) timeframe. 6 CTP offers other diagnostic utilities. 7 First, CTP may help differentiate ischemic stroke from stroke mimics, including seizure, migraine aura, and conversion disorder. [7][8][9] Although the suspicion for a stroke mimic should not be based solely on CTP, it may add supportive data and help clinicians better diagnose these elusive cases. Second, CTP may contribute valuable information for the selection of candidates for EVT and intravenous thrombolysis (IVT), despite a low NIHSS score. 3 The NIHSS gives much weight to motor function and dominant hemisphere. However, various infarcts may result in neurologic sequelae, not fully revealed by the NIHSS. 10 These patients may greatly benefit from IVT in case a penumbral lesion is identified. Third, CTP can demonstrate the severity of hypoperfusion in the presence of carotid occlusion or dissection and thus help determine the need for reperfusion therapy. 7,11 In this issue of the American Journal of Neuroradiology, Amukotuwa et al 12 examined the use of CTP to aid in interpretation of CTA for distal vessel occlusion (DVO) identification. They demonstrated that the use of time-to-maximum (Tmax) maps significantly improved the diagnostic performance for detecting DVO.Detection of DVO has great importance. The field of endovascular thrombectomy is rapidly emerging, and evidence is growing regarding the beneficial effect of EVT on distal M2 occlusions. 13 Furthermore, EVT targeting very distal occlusions including M3/