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A CT-based measure called perfusion mismatch ratio — already used in large vessel occlusion strokes — may also help predict outcomes in medium vessel occlusion strokes. A multinational trial of 94 patients found that higher mismatch ratios were significantly linked to smaller follow-up infarct volumes. Researchers say the findings could eventually guide decisions about who benefits most from mechanical thrombectomy, though more prospective studies are needed first.
A CT-based imaging measure called perfusion mismatch ratio — long used to guide treatment in large vessel occlusion (LVO) strokes — may have a similar role in medium vessel occlusion (MVO) strokes, according to a new multinational trial presented at the American Society of Functional Neuroradiology meeting.
In a study of 94 patients with isolated M2-segment occlusions, higher mismatch ratios were significantly associated with smaller follow-up infarct volumes, both in univariate and multivariate analyses. The mismatch ratio compares the volume of potentially salvageable hypoperfused tissue to the irrecoverable ischemic core. Notably, absolute mismatch volume — a related but distinct measure — was not predictive.
Researchers caution that this study does not yet support using mismatch ratio to guide treatment decisions in MVO strokes. For now, its value lies in prognostication — helping clinicians and families understand expected infarct burden. Future prospective trials are needed to determine whether low mismatch ratio patients are less likely to benefit from thrombectomy.
Key Takeaways:
Why it matters: Unlike LVO strokes, thrombectomy benefit in MVO strokes remains uncertain. This study lays the groundwork for using perfusion mismatch ratio to identify which MVO patients are most likely to benefit from intervention — a question with major implications for stroke care.
