Medium- and Distal-Vessel Occlusion — The Limit of Thrombectomy?

Background: Thrombectomy for stroke has shown significant benefits in large-vessel occlusions, but its efficacy in medium- and distal-vessel occlusions remains uncertain.

Methods: The ESCAPE-MeVO and DISTAL trials compared thrombectomy with best medical management in patients with medium- or distal-vessel occlusions. Outcomes included functional recovery, mortality, and bleeding complications.

Results: Thrombectomy provided no clinical benefit over medical management alone. The ESCAPE-MeVO trial reported higher mortality in the thrombectomy group (13.3% vs. 8.4%; adjusted hazard ratio, 1.82; 95% CI, 1.06–3.12), while DISTAL showed no significant difference (15.5% vs. 14.0%). Symptomatic intracranial hemorrhage rates were numerically higher with thrombectomy.

Conclusions: Thrombectomy for medium- or distal-vessel occlusions lacks evidence of benefit and may pose risks. Current practice should be reexamined, and alternative strategies explored.

Background: Thrombectomy for stroke has shown significant benefits in large-vessel occlusions, but its efficacy in medium- and distal-vessel occlusions remains uncertain.

Methods: The ESCAPE-MeVO and DISTAL trials compared thrombectomy with best medical management in patients with medium- or distal-vessel occlusions. Outcomes included functional recovery, mortality, and bleeding complications.

Results: Thrombectomy provided no clinical benefit over medical management alone. The ESCAPE-MeVO trial reported higher mortality in the thrombectomy group (13.3% vs. 8.4%; adjusted hazard ratio, 1.82; 95% CI, 1.06–3.12), while DISTAL showed no significant difference (15.5% vs. 14.0%). Symptomatic intracranial hemorrhage rates were numerically higher with thrombectomy.

Conclusions: Thrombectomy for medium- or distal-vessel occlusions lacks evidence of benefit and may pose risks. Current practice should be reexamined, and alternative strategies explored.