ABSTRACT NUMBER: ESOC2026A178 TARGET MISMATCH CRITERIA IN ACUTE ISCHEMIC STROKE PATIENTS WITH DISTAL-MEDIUM VESSEL OCCLUSION

Abstract Background and aims The efficacy of endovascular treatment in ischemic stroke patients with distal-medium vessel occlusion (DMVO) remains unclear. We evaluated whether CT-perfusion target mismatch criteria (TMC) could predict functional independence in patients with M2 non- or codominant middle cerebral artery DMVO. Methods Consecutive patients with DMVO receiving EVT and imaged with multimodal CT study protocol within 24h from onset were analyzed. A receiver operating characteristic curve analysis was used to identify the infarct core volume cutoff to predict functional independence (modified Rankin Scale 0–2 at 3-months). This parameter was subsequently considered as part of TMC together with penumbra volume⩾10mL and mismatch ratio ⩾1.2. The association between TMC and functional independence was tested with logistic regression. Results A total of 115 patients with DMVO were included. Infarct core volume had good discriminative ability for functional independence (AUC 0.75; 95%CI 0.64–0.84) and the best cut-off value was ⩽30mL (77% sensitivity, 61% specificity). TMC were independently associated with functional independence (OR [odds ratio]=6.50, 95%CI=2.37–17.77, p<0.001), excellent outcome (modified Rankin scale 0–1 at 3-months, OR=3.28, 95%CI=1.30–8.31, p=0.012) and final infarct volume (B=−35.52, p=0.004). After including interaction terms, a significant treatment effect on functional independence was observed between successful recanalization and TMC (OR=3.82, 95%CI=1.64–8.89, p=0.002). Conclusions In patients with M2 non- or codominant DMVO receiving EVT, TMC identified as core volume ⩽30 mL, penumbra volume ⩾ 10 mL, and mismatch ratio ⩾ 1.2, were associated with better functional outcome. Conflict of interest Giorgio Busto, MD: nothing to disclose