MRA/DWI Mismatch

See related article, pages 2491–2496. “Too much is never good; too little is never enough.” — —French proverb Lansberg et al present a further subanalysis (QUOTE) of the DEFUSE study.1 They assessed whether a more stringent “mismatch” concept than the usual perfusion imaging (PI)/diffusion-weighted imaging (DWI) mismatch would be a good tool to identify a target group, which might profit from early reperfusion enhanced by recombinant tissue plasminogen activator. In fact, they looked for patients with proximal middle cerebral artery occlusion or proximal stenosis with distal occlusion and a small DWI lesion (<25 mL respectively <15 mL). This of course is a smart thing to do, because the target group for treatment is further refined, albeit diminished in numbers. One could also increase the widely accepted mismatch ratio of 1.2 to 1.5, or 2.0, which would also optimize the target group at the cost of numbers of patients to …