Radiology. 2025 Nov;317(2):e251040. doi: 10.1148/radiol.251040.
ABSTRACT
Background Randomized trials have shown that endovascular thrombectomy (EVT) benefits patients with large vessel occlusion; however, its role in medium vessel occlusion remains unclear. Purpose To compare the efficacy and safety of EVT versus standard medical management in medium vessel occlusion stroke. Materials and Methods This multicenter, retrospective study enrolled patients with acute ischemic stroke from an occlusion of M3 or M4 segments of the middle cerebral artery, anterior cerebral artery, or posterior cerebral artery from 25 stroke centers (September 2019 to September 2024). The primary end point was an ordinal shift in 90-day modified Rankin Scale (mRS) scores. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage at 24 hours. Results A total of 1075 patients were included in the study (median age, 69 years; IQR, 59-76 years; 637 men; 529 treated with EVT and 546 treated with standard medical management; median baseline National Institutes of Health Stroke Scale [NIHSS], 10 [IQR, 6-12]). In the primary analysis using inverse probability of treatment weighting, there was an improvement in 90-day mRS distribution (adjusted common odds ratio, 1.38; 95% CI: 1.18, 1.61; P < .001) favoring EVT. Rates of mRS scores of 0-1 (43.7% [231 of 529 patients] vs 36.1% [197 of 546 patients]; adjusted risk ratio [RR], 1.61; 95% CI: 1.33, 1.96; P < .001) and mRS scores of 0-2 (60.9% [322 of 529 patients] vs 53.5% [292 of 546 patients]; adjusted RR, 1.39; 95% CI: 1.14, 1.69; P = .001) were higher with EVT. Between EVT and standard medical management groups, there was no difference in 90-day mortality (8.32% [44 of 529 patients] vs 8.97% [49 of 546 patients]; adjusted RR, 0.74; 95% CI: 0.51, 1.12; P = .17) or symptomatic intracranial hemorrhage (11.5% [61 of 529 patients] vs 10.4% [57 of 546 patients]; adjusted RR, 1.24; 95% CI: 0.92, 1.66; P = .16). Subgroup analyses indicated EVT benefit in patients with an NIHSS score of 6 or higher (adjusted RR, 1.62; 95% CI: 1.37, 1.92), but not in those with an NIHSS score of 1-5 (adjusted RR, 0.79; 95% CI: 0.58, 1.19; P value for interaction < .001). Conclusion Compared with standard medical management, EVT was associated with better outcomes in patients with acute medium vessel occlusion stroke, particularly those with more severe symptoms, without increasing symptomatic intracranial hemorrhage or 90-day mortality. Chinese Clinical Trial Registry no. ChiCTR2500096954 © The Author(s) 2025. Published by the Radiological Society of North America under a CC BY 4.0 license. Supplemental material is available for this article.
PMID:41288486 | DOI:10.1148/radiol.251040