Endovascular treatment (EVT) has become the standard of care for patients with acute ischemic stroke caused by large-vessel occlusion, significantly improving functional outcomes. However, its benefit for occlusions in medium or distal cerebral vessels remains uncertain. These smaller vessels present technical challenges for intervention, and previous evidence has been limited, leaving clinicians unsure whether EVT offers additional advantages over best medical therapy alone in this patient population. 

 

In a large trial, Prof. Marios Psychogios and his DKF research group in cooperation with Prof. Urs Fischer investigated whether EVT added benefit over best medical therapy for patients with ischemic stroke due to occlusion of medium or distal cerebral vessels. The results of the study were published in the N Engl J Med and awarded prizes from the Theodor Naegeli Foundation (CHF 100,000) and the Swiss Heart Foundation (CHF 20,000). 

 

Among 543 participants, there was no significant difference in the level of disability at 90 days, mortality, or symptomatic intracranial haemorrhage between the two groups. EVT did not reduce disability or death compared to best medical treatment alone for these types of strokes. Beyond the sobering findings on EVT efficacy, the study revealed that the long-term prognosis of patients with medium or distal vessel occlusion stroke was substantially worse than suggested by retrospective data, with nearly half of patients severely disabled or deceased at 90 days. 

 

Contrary to established benefits of EVT in large-vessel occlusions, this trial found no added benefit for medium or distal vessel occlusions. Further research is needed to identify which patients may benefit from EVT in these contexts.