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Updated: Jun 5, 2026
Transient Middle Cerebral Artery Occlusion Model of Stroke
Published on: August 11, 2023
Minor stroke with total mismatch after acute MCA occlusion
Joon-Tae Kim1, Man-Seok Park, Myeong-Kyu Kim
1Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea. alldelight2@jnu.ac.kr
Background:
Recently, "total mismatch," negative diffusion-weighted imaging (DWI) and extensive perfusion defects were introduced and described as having a favorable outcome after intravenous thrombolysis. We sought to determine the clinical characteristics of patients with total mismatch and describe their clinical courses.
Methods:
We retrospectively analyzed subjects from the stroke registry of acute ischemic stroke patients between August 2008 and October 2009. The patients with the following characteristics were included: acute ischemic stroke within 6 hours of symptom onset, a large artery occlusion in the anterior circulation and a negative DWI but large perfusion-weighted imaging (PWI) lesion on mean transit time maps. According to our stroke imaging protocol, the patients underwent emergent MR imaging immediately after admission and follow-up imaging within 96 hours of symptom onset.
Results:
Four patients were identified as suitable for the imaging criteria (negative DWI and MTT delay) of this study. All patients presented with a spontaneous recovery of ischemic symptoms related to the middle cerebral artery occlusion had a potential source of cardioembolism and eventually developed new lesions on follow-up DWI and recanalization without thrombolysis.
Conclusion:
In our study, total mismatch seems to suggest favorable outcome after recanalization, regardless of thrombolysis. Further attention should be focused on the considerable variations in PWI and DWI findings in acute stroke.
Insights
Total mismatch, characterized by negative diffusion-weighted imaging (DWI) and large perfusion defects, indicates a favorable outcome in acute ischemic stroke patients, regardless of thrombolysis treatment. This imaging profile suggests spontaneous recanalization is likely.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- "Total mismatch" is a recently described imaging profile in acute ischemic stroke.
- This profile includes negative diffusion-weighted imaging (DWI) and extensive perfusion defects.
- It has been associated with favorable outcomes following intravenous thrombolysis.
Purpose of the Study:
- To determine the clinical characteristics of patients presenting with "total mismatch."
- To describe the clinical courses of these patients.
- To investigate the prognostic significance of "total mismatch" in acute ischemic stroke.
Main Methods:
- Retrospective analysis of acute ischemic stroke patients (August 2008 - October 2009).
- Inclusion criteria: acute ischemic stroke within 6 hours, anterior circulation large artery occlusion, negative DWI, and large perfusion-weighted imaging (PWI) lesion (mean transit time maps).
- Patients underwent emergent MR imaging and follow-up imaging within 96 hours.
Main Results:
- Four patients met the "total mismatch" imaging criteria (negative DWI, MTT delay).
- All four patients experienced spontaneous recovery of ischemic symptoms.
- Recanalization occurred without thrombolysis, with new lesions on follow-up DWI observed in some cases.
Conclusions:
- "Total mismatch" appears to predict a favorable outcome after recanalization, independent of thrombolysis.
- Further research is needed to understand the variations in PWI and DWI findings in acute stroke.
- This imaging profile may guide treatment decisions and prognostication in acute ischemic stroke.
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