Mismatch-Time Ratio Combined with ASPECTS: A Novel Indicator of Favorable Prognosis in Multimodal CT prediction of Anterior Circulation Large Vessel Occlusion

Background Patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) require computed tomography(CT) at stroke centers to determine eligibility for endovascular therapy (EVT).However, the performance of prognostic prediction methods using multimodal CT remains unclear. This study aimed to investigate the significance of the mismatch–time ratio (MTR) of CT perfusion imaging (CTP) parameters of conjunction with Alberta Stroke Program Early Computed Tomography Score (ASPECTS) in non-contrast CT (NCCT) for predicting short-term prognosis following EVT in patients with anterior circulation AIS-LVO. Methods Patients with anterior circulation AIS-LVO who underwent EVT at the stroke specialty alliance of the Affiliated Hospital of Xuzhou Medical University from February 2023 to October 2024 were retrospectively were retrospectively included. The mismatch ratio defined by CTP parameters and the ratio of time from onset to CTP (T) were designated as the MTR. Based on the modified Rankin Scale (mRS) at 90 days after EVT, patients were categorized into a favorable prognosis group (mRS ≤ 3) and an adverse prognosis group (mRS > 3). Independent prognostic factors for favorable prognosis at 90 days post-EVT in patients with AIS-LVO were determined by univariate logistic regression and stepwise regression analyses. The predictive performance of MTR alone and the combined predictive efficacy of MTR with ASPECTS was compared via receiver operating characteristic (ROC) curve analysis for prognosis at 90 days post-EVT. Results 105 patients were enrolled, comprising 44 in the favorable prognosis group and 61 in the adverse prognosis group. Stepwise regression analysis revealed that MTR (OR = 2.072, P = 0.015, 95% CI: 1.155–3.719) and ASPECTS (OR = 2.363, P = 0.001, 95% CI: 1.445–3.866) were independent predictors of favorable prognosis. ROC curve analysis showed that MTR alone predicted a positive prognosis at 90 days post-EVT for AIS-LVO, with an AUC of 0.778 (P < 0.001). The combination of MTR and ASPECTS predicted a favorable prognosis at 90 days post-EVT for AIS-LVO, yielding an AUC of 0.828 (P < 0.001). Conclusion MTR serves as a novel imaging biomarker indicating positive short-term prognosis for EVT in patients with anterior circulation AIS-LVO. The integration of MTR with ASPECTS enhances the prognostic accuracy of EVT in patients with anterior circulation AIS-LVO.