No Benefit of EVT in Medium-Vessel Occlusion Stroke

TOPLINE:

Endovascular thrombectomy (EVT) vs usual care for acute ischemic stroke due to medium-vessel occlusion did not improve outcomes at 9src days and was linked to increased mortality.

METHODOLOGY:

• Researchers conducted a multicenter, prospective, randomized, open-label trial including 53src patients across five countries between 2src22 and 2src24.
• Participants with acute ischemic stroke due to medium-vessel occlusion, presenting within 12 hours, were randomly assigned to receive either EVT plus usual care (255 patients) or usual care alone (275 patients).
• The primary outcome was the modified Rankin Scale (mRS) score at 9src days.
• Analysis included the assessment of successful reperfusion using the Medium Vessel Occlusion-expanded Thrombolysis in Cerebral Ischemia score, with higher scores indicating greater reperfusion.

TAKEAWAY:

• The primary outcome did not differ significantly between the groups, with an mRS score of src or 1 in 41.6% of patients in the EVT group vs 43.1% of patients in the usual care group (adjusted rate ratio, src.95; 95% CI, src.79-1.15; P=.61).
• The risk for mortality was higher in the EVT group than in the usual care group (13.3% vs 8.4%; adjusted hazard ratio, 1.82; 95% CI, 1.src6-3.12).
• Serious adverse events were more frequent in the EVT group (33.9%) than in the usual care group (25.7%), with pneumonia, stroke progression, and recurrent stroke being the most common. Symptomatic intracranial hemorrhage occurred more frequently in the EVT group (5.4%) than in the usual care group (2.2%).

IN PRACTICE:

The authors wrote, “The results of our trial do not support routine endovascular treatment of acute ischemic stroke due to medium-vessel occlusion.” They added, “Further work is needed to improve the safety profile of the EVT procedure and to identify a population of patients who may benefit from this treatment approach.”

SOURCE:

The study was led by Mayank Goyal, MD, PhD, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada. It was published online on February 5, 2src25, in The New England Journal of Medicine.

LIMITATIONS:

Technical EVT success could not be achieved in all cases. The workflow times in this trial were longer than those in previous trials involving large-vessel occlusion. Additionally, decision-making may have been more nuanced for medium-vessel occlusion than for large-vessel occlusion, potentially contributing to treatment delays.

DISCLOSURES:

The study was funded by the Canadian Institutes for Health Research and Medtronic. Several authors reported having affiliations and/or financial relationships with medical device and pharmaceutical companies, including consulting fees, research grants, stock holdings, and honoraria. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.