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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Endovascular Treatment for Acute Ischemic Stroke Due to Medium Vessel Occlusion: A Systematic Review with

Farsana Mustafa1, Baikuntha Panigrahi2, Partha Haldar3

  • 1Department of Neurology, All India Institute of Medical Scienceshttps://ror.org/02dwcqs71, New Delhi, India.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|November 13, 2025
PubMed
Abstract

Insights

Endovascular treatment (EVT) for acute ischemic stroke (AIS) from medium vessel occlusion (MeVO) does not improve patient outcomes. EVT is linked to increased risks of symptomatic intracranial hemorrhage and serious adverse events compared to best medical treatment.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Public Health

Background:

  • Medium vessel occlusion (MeVO) accounts for a significant proportion of acute ischemic strokes (AIS).
  • The efficacy and safety of endovascular treatment (EVT) for AIS due to MeVO remain uncertain, with recent randomized controlled trials (RCTs) yielding neutral results.
  • This meta-analysis synthesizes evidence to clarify the role of EVT in MeVO.

Purpose of the Study:

  • To evaluate the pooled efficacy of EVT in improving functional outcomes for patients with AIS due to MeVO.
  • To assess the safety profile of EVT, specifically the risk of symptomatic intracranial hemorrhage (sICH) and serious adverse events (SAEs).
  • To provide evidence-based insights for clinical decision-making in managing AIS with MeVO.

Main Methods:

  • A systematic review and meta-analysis of two relevant RCTs (DISTAL and ESCAPE-MeVO) were performed.
  • A total of 1073 participants were included in the analysis.
  • Primary outcome: excellent functional outcome (modified Rankin score [mRS] 0-1 at 90 days). Secondary outcomes: mRS 0-2, sICH, and mortality.

Main Results:

  • No significant difference in excellent functional outcome (mRS 0-1) between EVT and best medical treatment (BMT) was observed (RR: 0.95, 95% CI: 0.81-1.10).
  • Similarly, no significant difference was found for functional outcome of mRS 0-2 (RR: 0.98, 95% CI: 0.88-0.09).
  • EVT was associated with a significantly higher risk of sICH (RR: 2.39, 95% CI: 1.26-4.53) and SAEs (RR: 1.32, 95% CI: 1.11-1.56) compared to BMT.

Conclusions:

  • Endovascular treatment for AIS due to MeVO does not confer better functional outcomes at 90 days compared to best medical treatment.
  • EVT in this patient population is associated with an increased risk of symptomatic intracranial hemorrhage and serious adverse events.
  • Trial sequential analysis confirmed these findings, suggesting that EVT is not beneficial and potentially harmful for MeVO strokes.
Keywords:
DISTALESCAPE-MeVObest medical treatmentendovascular treatmentmedium vessel occlusion

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