Neuroimaging in Distal & Medium Vessel Occlusions

Distal medium vessel occlusions (DMVOs), as a cause of acute ischemic stroke, typically present with unique challenges in diagnosis and treatment owing to their anatomical variability, heterogeneous clinical manifestations, and limitations in current imaging techniques. Computed tomography angiography (CTA) often fails to detect DMVOs accurately, necessitating the use of alternative imaging modalities such as time-to-maximum (Tmax) maps, which have shown significantly higher sensitivity. Emerging artificial intelligence (AI) tools offer promising diagnostic support but require further validation. Endovascular thrombectomy (EVT) for DMVOs remains a subject of debate, with ongoing efforts to refine techniques and develop more navigable and effective devices. Current evidence is largely limited to single-center studies, emphasizing the need for large-scale, multicenter trials to establish standardized protocols and improve clinical outcomes.