In acute stroke with proximal artery occlusion, FLAIR vascular hyperintensities observed beyond the boundaries of the cortical lesion on DWI (newly defined "FLAIR vascular hyperintensity-DWI mismatch") may be a marker of tissue at risk of infarction. Our aim was to compare the occurrence of FLAIR vascular hyperintensity-DWI mismatch relative to that of perfusion-weighted imaging-DWI mismatch in patients with proximal MCA occlusion before IV thrombolysis.