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Updated: Jun 5, 2026
05:32
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
Summary
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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