Cerebrovascular diseases (Basel, Switzerland) · 2026
Is Endovascular Thrombectomy Effective for Distal Medium Vessel Occlusion Stroke? A Meta-Analysis of Randomized Controlled Trials and Observational Studies.
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Wu Jian, Yan Fuli, Li Jiaying, Huang Junlong, Yang MingFei, Ju Zhanying
Аннотация
BACKGROUND: Evidence on endovascular thrombectomy (EVT) for distal medium vessel occlusion (DMVO) stroke remains insufficient, and its efficacy across severity levels is unclear.
METHODS: Systematic search of databases for RCTs and observational studies comparing EVT versus best medical treatment (BMT) in DMVO patients. Patients were stratified by NIHSS (<6, ≥6, unreported) and occlusion site (MCA, PCA, ACA).
PRIMARY OUTCOME: 90-day mRS 0-1.
SECONDARY OUTCOMES: mRS 0-2, mortality, and symptomatic intracranial hemorrhage (sICH).
RESULTS: 3 RCTs (n=1,233) and 39 observational studies (n=11,148) were included. RCTs showed no significant difference between EVT+BMT and BMT alone in mRS 0-1 (RR 0.95, 95% CI 0.82-1.10), mRS 0-2 (RR 0.92, 95% CI 0.80-1.06), or mortality (OR 1.23, 95% CI 0.76-1.99), but EVT significantly increased sICH risk (OR 2.38, 95% CI 1.35-4.20, p=0.003). Observational studies similarly found no differences in functional outcomes or mortality, with elevated sICH in the EVT group (OR 1.69, 95% CI 1.14-2.50, p=0.008). Subgroup analyses suggested a potential gradient effect: in NIHSS ≥6 patients, EVT showed no significant benefit in primary analysis, but a sensitivity analysis excluding heterogeneous studies yielded a potential signal (mRS 0-1: RR 1.18, 95% CI 1.01-1.37, p=0.04). Conversely, in NIHSS <6 patients, BMT alone appeared non-inferior (RR 0.91, 95% CI 0.82-1.00, p=0.05).
CONCLUSION: EVT does not improve functional outcomes in overall DMVO but increases sICH risk. Exploratory analyses suggest EVT may benefit more severe (NIHSS ≥6) or proximal occlusion patients, whereas BMT alone may suffice for milder cases. These findings are hypothesis-generating and require RCT validation.
METHODS: Systematic search of databases for RCTs and observational studies comparing EVT versus best medical treatment (BMT) in DMVO patients. Patients were stratified by NIHSS (<6, ≥6, unreported) and occlusion site (MCA, PCA, ACA).
PRIMARY OUTCOME: 90-day mRS 0-1.
SECONDARY OUTCOMES: mRS 0-2, mortality, and symptomatic intracranial hemorrhage (sICH).
RESULTS: 3 RCTs (n=1,233) and 39 observational studies (n=11,148) were included. RCTs showed no significant difference between EVT+BMT and BMT alone in mRS 0-1 (RR 0.95, 95% CI 0.82-1.10), mRS 0-2 (RR 0.92, 95% CI 0.80-1.06), or mortality (OR 1.23, 95% CI 0.76-1.99), but EVT significantly increased sICH risk (OR 2.38, 95% CI 1.35-4.20, p=0.003). Observational studies similarly found no differences in functional outcomes or mortality, with elevated sICH in the EVT group (OR 1.69, 95% CI 1.14-2.50, p=0.008). Subgroup analyses suggested a potential gradient effect: in NIHSS ≥6 patients, EVT showed no significant benefit in primary analysis, but a sensitivity analysis excluding heterogeneous studies yielded a potential signal (mRS 0-1: RR 1.18, 95% CI 1.01-1.37, p=0.04). Conversely, in NIHSS <6 patients, BMT alone appeared non-inferior (RR 0.91, 95% CI 0.82-1.00, p=0.05).
CONCLUSION: EVT does not improve functional outcomes in overall DMVO but increases sICH risk. Exploratory analyses suggest EVT may benefit more severe (NIHSS ≥6) or proximal occlusion patients, whereas BMT alone may suffice for milder cases. These findings are hypothesis-generating and require RCT validation.