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The following is a summary of “Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion,” published in the February 2025 issue of New England Journal of Medicine by Goyal et al. 

Researchers conducted a retrospective study to evaluate whether endovascular thrombectomy (EVT) benefits for large-vessel occlusion extend to medium-vessel occlusion. 

They conducted a multicenter, prospective, randomized, open-label trial with blinded outcome evaluation. They enrolled patients with acute ischemic stroke due to medium-vessel occlusion within 12 hours, with favorable baseline noninvasive brain imaging, to receive EVT plus usual care or usual care alone. The primary outcome was the modified Rankin scale score (0–6) at 90 days, reported as the percentage of patients with a score of 0 or 1. 

The results showed that 530 patients from 5 countries, 255 received EVT, and 275 received usual care. Primary occlusions in a middle-cerebral-artery branch were 84.7%. A modified Rankin scale score of 0 or 1 at 90 days occurred in 41.6% of the EVT group and 43.1% of the usual-care group (adjusted rate ratio, 0.95; 95% CI, 0.79–1.15; P=0.61). Mortality at 90 days was 13.3% with EVT and 8.4% with usual care (adjusted hazard ratio (HR), 1.82; 95% CI, 1.06–3.12). Symptomatic intracranial hemorrhage occurred in 14 of 257 patients (5.4%) with EVT and 6 of 272 (2.2%) with usual care. 

Investigators found that endovascular treatment for acute ischemic stroke due to medium-vessel occlusion within 12 hours did not improve 90-day outcomes compared to usual care. 

Source: nejm.org/doi/full/10.1056/NEJMoa2411668