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Updated: Jun 1, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Usefulness of MRA-DWI mismatch in neuroendovascular therapy for acute cerebral infarction
I Deguchi1, T Dembo, T Fukuoka
1Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan. ideguchi@saitama-med.ac.jp
Background:
This study evaluated the usefulness of MR angiography (MRA)-diffusion-weighted imaging (DWI) mismatch in neuroendovascular therapy over 3 h after onset of acute cerebral infarction.
Methods:
The subjects were 14 cases (age, 73 ± 8.4 years) who had an anterior circulation deficit on DWI/MRA on arrival and underwent neuroendovascular therapy over 3 h after onset. MRA-DWI mismatch (MDM) (+) was defined as 'major artery lesion (+) and diffusion-weighted image-Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≥6'; MDM (-) was defined as 'major artery lesion (+) and DWI-ASPECTS <6'.
Results:
Reperfusion was achieved in nine of 14 patients (64%) undergoing neuroendovascular therapy. Within the reperfusion group, in the five MDM (+) patients and the four MDM (-) patients, the outcome was a favorable clinical response in the MDM (+) group. The modified Rankin Scale (mRS) scores after 90 days were 0-2 in 3 (60%) and 3-6 in 2 (40%) of the MDM (+) group patients and 0-2 in 0 (0%) and 3-6 in 4 (100%) of the MDM (-) group patients. In the MDM (+) group, a good outcome was achieved. However, the number of cases was small, so this was not a significant difference. Within the non-reperfusion group, in the three MDM (+) patients and the two MDM (-) patients, the mRS scores after 90 days were 0-2 in 1 (33%) and 3-6 in 2 (67%) of the MDM (+) group patients and 0-2 in 0 (0%) and 3-6 in 2 (100%) of the MDM (-) group patients. In both groups, the outcome was poor.
Conclusions:
With neuroendovascular therapy, a good outcome with reperfusion was achieved in the MDM (+) group compared to the MDM (-) group. This suggests that the presence or absence of MDM may be useful in determining prognosis after reperfusion.
Insights
The MR angiography (MRA)-diffusion-weighted imaging (DWI) mismatch (MDM) may predict outcomes in acute cerebral infarction patients receiving neuroendovascular therapy. MDM-positive patients showed better reperfusion and clinical responses compared to MDM-negative patients.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Acute cerebral infarction requires timely intervention.
- Neuroendovascular therapy is a crucial treatment option for selected patients.
- Predictive markers for treatment success are essential.
Purpose of the Study:
- To evaluate the utility of MR angiography (MRA)-diffusion-weighted imaging (DWI) mismatch (MDM) in predicting outcomes.
- To assess the effectiveness of neuroendovascular therapy in patients with acute cerebral infarction.
- To determine if MDM can guide therapeutic decisions and prognosis.
Main Methods:
- Retrospective analysis of 14 patients with anterior circulation deficit treated with neuroendovascular therapy within 3 hours of stroke onset.
- Definition of MRA-DWI mismatch (MDM): MDM (+) defined as major artery lesion present and DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS) ≥6; MDM (-) defined as major artery lesion present and DWI-ASPECTS <6.
- Assessment of reperfusion rates and modified Rankin Scale (mRS) scores at 90 days post-treatment.
Main Results:
- Reperfusion was achieved in 64% of patients (9/14).
- In the reperfusion group, MDM (+) patients (n=5) had a favorable clinical response (mRS 0-2 in 60%) compared to MDM (-) patients (n=4) (mRS 0-2 in 0%).
- In the non-reperfusion group, outcomes were poor regardless of MDM status, though MDM (+) patients (n=3) showed slightly better results (mRS 0-2 in 33%) than MDM (-) patients (n=2) (mRS 0-2 in 0%).
Conclusions:
- Neuroendovascular therapy can lead to good outcomes in acute cerebral infarction.
- The presence of MRA-DWI mismatch (MDM) is associated with better outcomes after successful reperfusion.
- MDM status may serve as a useful prognostic indicator for patients undergoing neuroendovascular therapy.