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Conclusion: Early Holter ECG monitoring in hospitalized ESUS patients significantly increased the detection rate of PUAF compared to ambulatory monitoring, highlighting the importance of timely cardiac assessment in stroke management Disclosure of interest: nothing to disclose Poster Session II - ACUTE ISCHEMIC STROKE MANAGEMENT 01.00 - ACUTE ISCHEMIC STROKE MANAGEMENT - 01.06 - IMAGING - Hyperacute P676 - ESOC25-1097 PENUMBRAL PERFUSION PATTERNS IN ACUTE ISCHEMIC STROKE WITH LARGE AND MEDIUM VESSEL OCCLUSION: A POST HOC ANALYSIS OF THE ACT TRIAL Sibi Thirunavukkarasu 1 , Nishita Singh 2 , Jianhai Zhang 3 , MacKenzie Horn 3 , Aravind Ganesh 3 , Wu Qiu 4 , Fouzi Bala 3 , Federico Carpani 5 , Alexander Khaw 6 , Dar Dowlatshahi 7 , Gary Hunter 8 , Thalia Field 9 , Luciana Catanese 10 , Aleksander Tkach 11 , Mohammed Almekhlafi 3 , Richard Swartz 5 , Tolulope Sajobi 3 , Brian Buck 1 , Bijoy Menon 3 , Mahesh Kate 1 1 University of Alberta, Edmonton, Canada, 2 University of Manitoba, Winnipeg, Canada, 3 University of Calgary, Calgary, Canada, 4 Huazhong University of Science and Technology, Wuhan, China, 5 University of Toronto, Toronta, Canada, 6 Western University, London, Canada, 7 University of Ottawa, Ottawa, Canada, 8 University of Saskatchewan, Saskatoon, Canada, 9 University of British Columbia, Vancouver, Canada, 10 McMaster University/Population Health Research Institute, Hamilton, Canada, 11 Kelowna General Hospital, Kelowna, Canada Background and Aims: The role of Computed Tomography perfusion (CTP) in early-window ischemic stroke is debatable