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Updated: Jan 9, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

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Mechanical Thrombectomy Versus Best Medical Treatment for Patients with Acute Ischemic Stroke and Primary Distal

Giancarlo Salsano1, Bruno Del Sette2, Marco Bruzzone3

  • 1UOC Neuroradiologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy. giancarlo.salsano@yahoo.it.

Clinical Neuroradiology
|December 10, 2025
PubMed
Abstract

Insights

Mechanical thrombectomy (MT) does not improve functional independence or reduce mortality in distal medium vessel occlusions (DMVO) stroke patients compared to best medical therapy (BMT). Subarachnoid hemorrhage rates were higher with MT.

Area of Science:

  • Neurology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Distal medium vessel occlusions (DMVO) present a significant challenge in stroke treatment.
  • Limited evidence exists comparing mechanical thrombectomy (MT) to best medical therapy (BMT) for DMVO.
  • Key outcomes include functional status, mortality, and hemorrhage rates.

Purpose of the Study:

  • To compare clinical outcomes of MT versus BMT in DMVO stroke patients.
  • To evaluate functional independence, mortality, and complication rates.
  • To provide evidence for treatment strategy selection in DMVO.

Main Methods:

  • Meta-analysis of studies comparing MT and BMT for DMVO ischemic stroke.
  • Inclusion of randomized controlled trials and observational studies.
  • Assessment of functional independence (mRS 0-2), excellent outcome (mRS 0-1), mortality, ENI, sICH, and SAH.

Main Results:

  • 28 studies involving 7512 patients were analyzed.
  • No significant differences in functional independence or excellent outcomes between MT and BMT.
  • No significant differences in overall mortality, early neurological improvement, or symptomatic intracranial hemorrhage (sICH).
  • Higher rates of subarachnoid hemorrhage (SAH) observed in the MT group.

Conclusions:

  • Current meta-analysis does not support routine MT for DMVO.
  • MT plus BMT did not increase functional independence or reduce mortality compared to BMT alone.
  • Increased SAH rates necessitate careful consideration of MT risks in DMVO.
Keywords:
Best medical treatmentDistal medium vessel occlusionMechanical thrombectomyPrimary occlusion

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