Who wins Sion vs Karthus?
MID.GG has 2 high-elo VODs of this matchup so far, not enough games yet to call it.
In 2 high-elo games (latest patch 26.20), Sion won 50% against Karthus. The average game ended 5.0/8.0/8.5 for Sion. That is not enough games yet to say who the matchup favours.
One Sion setup into Karthus takes Stormraider's Surge (Sorcery and Inspiration) and builds Youmuu's Ghostblade and Bastionbreaker. It shows up in 1 of 2 games. The main alternative also takes Stormraider's Surge but runs Axiom Arcanist (1 game).
Taken from the 2 VODs on this page, patch 26.19 and 26.20.
Every streamer in the library with ranked Sion games, most games first. Each links to their VODs on MID.GG.
MID.GG has 2 high-elo VODs of this matchup so far, not enough games yet to call it.
No rune page repeats yet in the 2 high-elo VODs on MID.GG; one game ran the Stormraider's Surge rune page, building Youmuu's Ghostblade and Bastionbreaker first.
The most recent games in this matchup, newest first.

