Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion
Authors: Mayank Goyal, Johanna M Ospel, Aravind Ganesh, Dar Dowlatshahi, David Volders, Markus A Möhlenbruch, Mouhammad A Jumaa, Shahid M Nimjee, Thomas C Booth, Brian H Buck, James Kennedy, Jai J Shankar, Franziska Dorn, Liqun Zhang, Christian Hametner, Sandor Nardai, Atif Zafar, William Diprose, Shabnam Vatanpour, Alexander Stebner, Salome Bosshart, Nishita Singh, Ivy Sebastian, Kazutaka Uchida, Karla J Ryckborst, Robert Fahed, Sherry X Hu, Dominik F Vollherbst, Syed F Zaidi, Vivien H Lee, Jeremy Lynch, Jeremy L Rempel, Rachel Teal, Anurag Trivedi, Felix J Bode, Ayokunle Ogungbemi, Mirko Pham, Peter Orosz, Mohamad Abdalkader, Christian Taschner, Jason Tarpley, Sven Poli, Ravinder-Jeet Singh, Reade De Leacy, George Lopez, Demetrios Sahlas, Michael Chen, Paul Burns, Joanna D Schaafsma, Richard Marigold, Arno Reich, Adewumi Amole, Thalia S Field, Richard H Swartz, Fabio Settecase, Gábor Lenzsér, Santiago Ortega-Gutierrez, Negar Asdaghi, Kyriakos Lobotesis, Adnan H Siddiqui, Joerg Berrouschot, Maxim Mokin, Koji Ebersole, Hauke Schneider, Albert J Yoo, Jennifer Mandzia, Jesse Klostranec, Changez Jadun, Tufail Patankar, Eric Sauvageau, Robert Lenthall, Lissa Peeling, Thien Huynh, Ronald Budzik, Seon-Kyu Lee, Levansri Makalanda, Michael R Levitt, Richard J Perry, Thant Hlaing, Babak S Jahromi, Paul Singh, Andrew M Demchuk, Michael D Hill
Journal: New England Journal of Medicine (2025)

BackgroundWhether the large effect size of endovascular thrombectomy (EVT) for stroke due to large-vessel occlusion applies to stroke due to medium-vessel occlusion is unclear.MethodsIn a multicenter, prospective, randomized, open-label trial with blinded outcome evaluation, we assigned patients with acute ischemic stroke due to medium-vessel occlusion who presented within 12 hours from the time that they were last known to be well and who had favorable baseline noninvasive brain imaging to receive EVT plus usual care or usual care alone. The primary outcome was the modified Rankin scale score (range, 0 [no symptoms] to 6 [death]) at 90 days, reported as the percentage of patients with a score of 0 or 1.ResultsA total of 530 patients from five countries were enrolled between April 2022 and June 2024, with 255 patients assigned to the EVT group and 275 to the usual-care group. Most patients (84.7%) had primary occlusions in a middle-cerebral-artery branch. A modified Rankin scale score of 0 or 1 at 90 days occurred in 106 of 255 patients (41.6%) in the EVT group and in 118 of 274 (43.1%) in the usual-care group (adjusted rate ratio, 0.95; 95% confidence interval [CI], 0.79 to 1.15; P=0.61). Mortality at 90 days was 13.3% in the EVT group and 8.4% in the usual-care group (adjusted hazard ratio, 1.82; 95% CI, 1.06 to 3.12). Symptomatic intracranial hemorrhage occurred in 14 of 257 patients (5.4%) in the EVT group and in 6 of 272 (2.2%) in the usual-care group.ConclusionsEndovascular treatment for acute ischemic stroke due to medium-vessel occlusion within 12 hours did not lead to better outcomes at 90 days than usual care. (Funded by the Canadian Institutes for Health Research and Medtronic; ESCAPE-MeVO ClinicalTrials.gov number, NCT05151172.)