• Janet Mei, Hamza Adel Salim, Dhairya A Lakhani, Aneri Balar, Vaibhav Vagal, Manisha Koneru, Dylan Wolman, Risheng Xu, Victor Urrutia, Elisabeth Breese Marsh, Benjamin Pulli, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Mona Bahouth, Adam A Dmytriw, Adrien Guenego, Gregory W Albers, Hanzhang Lu, Kambiz Nael, Argye E Hillis, Raf Llinas, Max Wintermark, Tobias D Faizy, Jeremy J Heit, and Vivek Yedavalli.
• Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
• J Neuroimaging. 2025 Jan 1; 35 (1): e70015e70015.

Background And PurposeProlonged length of stay (LOS) following a stroke is associated with unfavorable clinical outcomes. Factors predicting LOS in medium vessel occlusion (MeVO), impacting up to 40% of acute ischemic stroke (AIS) cases, remain underexplored. This study aims to investigate the predictors of LOS in AIS-MeVO.MethodsWe conducted a retrospective analysis of prospectively maintained stroke databases, comprising AIS cases with MeVO in the anterior circulation, assessed by adequate CT perfusion (CTP). Baseline and clinical data were obtained from electronic health records. Alberta Stroke Program Early CT Scores (ASPECTS) were calculated from non-contrast head CT. The perfusion mismatch volume (time to maximum > 6 s minus relative cerebral blood flow <30%) volume was reported from CTP. Multiple regression was employed to examine the relationship between baseline parameters and hospital LOS.ResultsA total of 133 patients (median age 71 [interquartile range 63-80] years, 59.4% females) were included in the study cohort. The perfusion mismatch volume significantly positively correlated with LOS (r = 0.264, p = 0.004). After adjusting for age, sex, hypertension, diabetes, prior stroke or transient ischemic attack, admission NIHSS, ASPECTS, Tan score, intravenous thrombolysis, mechanical thrombectomy (MT), and hemorrhagic transformation, a larger mismatch volume remained independently associated with longer hospital stays (β = 0.209, 95% confidence interval [CI] 0.006-0.412, p = 0.045). Additional significant determinants of longer hospital stay included admission NIHSS (β = 0.250, 95% CI: 0.060-0.440, p = 0.010) and MT (β = 0.208, 95% CI: 0.006-0.410, p = 0.044). Among patients who underwent MT (n = 83), multiple regression analysis incorporating both perfusion mismatch volume and admission NIHSS revealed that perfusion mismatch volume remained independently associated with LOS (β = 0.248, 95% CI: 0.019-0.471, p = 0.033), while admission NIHSS did not retain significance (β = 0.208, 95% CI: 0.019-0.433, p = 0.071).ConclusionsIn our cohort of AIS patients with MeVO in the anterior circulation, and particularly in those who underwent MT, the perfusion mismatch volume serves as an independent predictor of LOS. These findings offer critical valuable insights in clinical assessments and decision-making protocols of MT in AIS-MeVO.© 2025 American Society of Neuroimaging.

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