• N. Engl. J. Med. · Feb 2025

    Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion.

    • 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, and ESCAPE-MeVO Investigators.
    • Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
    • N. Engl. J. Med. 2025 Feb 5.

    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.).Copyright © 2025 Massachusetts Medical Society.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…