Endovascular treatment for ischemic stroke due to distal medium vessel occlusions: A nationwide multicenter registry

The effectiveness and safety of endovascular treatment (EVT) for acute ischemic stroke attributable to distal medium vessel occlusion (DMVO) remain uncertain. This study aimed to compare the effectiveness and safety of EVT plus standard medical treatment (SMT) versus SMT alone in patients with DMVO.

This nationwide multicenter registry included patients with DMVO presenting within 24 h of last known well at 116 sites in China between 2023 and 2025. The primary outcome was freedom from disability (modified Rankin Scale score of 0-1) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 h and 90-day mortality. The primary analysis was conducted using inverse probability of treatment weighting.

Among 2,524 patients, 1,564 received EVT plus SMT, and 960 received SMT alone. EVT plus SMT was associated with a higher rate of freedom from disability at 90 days compared with SMT alone (adjusted risk ratio [aRR], 1.15; 95% confidence interval [CI], 1.02-1.29; adjusted risk difference, 4.36%; 95% CI, 1.73%-6.99%). However, EVT plus SMT was associated with an increased risk of sICH (aRR, 4.03; 95% CI, 2.46-6.59). Mortality at 90 days did not differ significantly between the groups (aRR, 0.97; 95% CI, 0.81-1.16).

In patients with DMVO, EVT plus SMT was associated with a modestly higher rate of freedom from disability at 90 days but an increased risk of sICH.

National Natural Science Foundation of China (82425021, 82571498, and 82271349), Natural Science Foundation of Chongqing (CSTB2024NSCQ-MSX0359 and CSTB2024NSCQ-KJFZMSX0063), and Chongqing Technology Innovation and Application Development Project (CSTB2022TIAD-KPX0160).