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Background: Standard selection criteria for revascularization therapy usually exclude patients with unclear- onset stroke. Our aim was to evaluate the efficacy and safety of revascularization therapy in patients with unclear-onset stroke in the anterior circulation using diffusion and FLAIR weighted images. Methods: A total of 20 patients were analyzed. They were presenting with acute stroke with unknown time of onset treated by mechanical thrombectomy. Only patients without well-developed fluid-attenuated inversion recovery changes of acute diffusion lesions on MR imaging were enrolled. Clinical outcome was evaluated at 7 days by using the mRS scale. Mortality and symptomatic intracranial hemorrhage were also reported. Results: DWI changes were positive in the 20 patients, FLAIR was negative in 16 patients and mildly positive in 4 patients; the condition on discharge as assessed by the modified Rankin score was found to be that score from zero to 2 constituted 80% of the study population regardless of the time onset of the stroke. Conclusion: DWI-FLAIR mismatch criteria with clinical data pre-thrombectomy can be used safely and efficiently to select patients eligible for thrombectomy.