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Updated: Aug 13, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular thrombectomy for stroke due to medium vessel occlusion: a meta-analysis of randomized controlled trials
Hamayal Muhammad1, Dania Al Wazen2, Esha Habib1
1Department of Neurology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan.
Background:
Medium vessel occlusion (MeVO) strokes are a unique subgroup with potentially debilitating results, with limited literature on treatment options. This meta-analysis assesses the efficacy of endovascular thrombectomy (EVT) in MeVO stroke.
Methods:
Science Direct, PubMed, and The Cochrane Library were searched for randomized controlled trials from 2010 to 2025. All studies included MeVO stroke patients aged ≥18 years, NIHSS ≥5, and those undergoing EVT. Endpoints included modified Rankin Scale (mRS) score (0-1), symptomatic intracranial hemorrhage (SICH), and mortality. ROB2 was used to assess the quality of studies, and risk ratios (RRs) were calculated. The protocol was registered on PROSPERO.
Results:
Only four trials were included from the original 5912 articles retrieved. Results showed mRS score improvement with EVT [RR 1.09; 95% confidence interval (CI) 0.84-1.42; P = 0.54], while showing a minor increase in SICH with EVT (RR 1.54; 95% CI 0.48-5.00; P = 0.47). No difference was observed in mortality between the two groups (RR 1.00; 95% CI 0.55-1.79; P = 0.99). None of the results were statistically significant.
Conclusion:
Endovascular therapy showed no significant benefit in MeVO stroke; however, existing data are inconclusive and require further research.
Insights
Endovascular thrombectomy (EVT) showed no significant benefit for medium vessel occlusion (MeVO) strokes. More research is needed to determine effective treatments for this stroke subtype.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Medium vessel occlusion (MeVO) strokes represent a distinct and severe subtype with limited established treatment options.
- Existing literature on therapeutic interventions for MeVO strokes is scarce, necessitating further investigation.
Purpose of the Study:
- To conduct a meta-analysis evaluating the efficacy of endovascular thrombectomy (EVT) in patients with MeVO strokes.
- To assess the impact of EVT on functional outcomes, symptomatic intracranial hemorrhage, and mortality in MeVO stroke patients.
Main Methods:
- A systematic literature search was performed on Science Direct, PubMed, and The Cochrane Library for randomized controlled trials published between 2010 and 2025.
- Studies included adult patients (≥18 years) with MeVO stroke, a National Institutes of Health Stroke Scale (NIHSS) score of ≥5, and who underwent EVT.
- Key endpoints were modified Rankin Scale (mRS) scores (0-1), symptomatic intracranial hemorrhage (SICH), and mortality. Study quality was assessed using ROB2, and risk ratios (RRs) were calculated.
Main Results:
- Out of 5912 retrieved articles, only four trials met the inclusion criteria.
- EVT demonstrated a non-significant trend towards improved mRS scores (RR 1.09; 95% CI 0.84-1.42; P=0.54).
- A non-significant increase in SICH (RR 1.54; 95% CI 0.48-5.00; P=0.47) and no difference in mortality (RR 1.00; 95% CI 0.55-1.79; P=0.99) were observed with EVT.
Conclusions:
- Current evidence suggests endovascular therapy does not provide a significant benefit for MeVO strokes.
- The existing data are inconclusive, highlighting the need for further high-quality research to establish optimal treatment strategies for MeVO strokes.
