Journal article
Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion
The New England journal of medicine, Vol.392(14), pp.1385-1395
04/10/2025
DOI: 10.1056/NEJMoa2411668
PMID: 39908448
Abstract
Whether the large effect size of endovascular thrombectomy (EVT) for stroke due to large-vessel occlusion applies to stroke due to medium-vessel occlusion is unclear.
In a multicenter, prospective, randomized, open-label trial with blinded outcome evaluation, we assigned patients with acute ischemic stroke due to medium-vessel occlusion who presented within 12 hours from the time that they were last known to be well and who had favorable baseline noninvasive brain imaging to receive EVT plus usual care or usual care alone. The primary outcome was the modified Rankin scale score (range, 0 [no symptoms] to 6 [death]) at 90 days, reported as the percentage of patients with a score of 0 or 1.
A total of 530 patients from five countries were enrolled between April 2022 and June 2024, with 255 patients assigned to the EVT group and 275 to the usual-care group. Most patients (84.7%) had primary occlusions in a middle-cerebral-artery branch. A modified Rankin scale score of 0 or 1 at 90 days occurred in 106 of 255 patients (41.6%) in the EVT group and in 118 of 274 (43.1%) in the usual-care group (adjusted rate ratio, 0.95; 95% confidence interval [CI], 0.79 to 1.15; P = 0.61). Mortality at 90 days was 13.3% in the EVT group and 8.4% in the usual-care group (adjusted hazard ratio, 1.82; 95% CI, 1.06 to 3.12). Symptomatic intracranial hemorrhage occurred in 14 of 257 patients (5.4%) in the EVT group and in 6 of 272 (2.2%) in the usual-care group.
Endovascular treatment for acute ischemic stroke due to medium-vessel occlusion within 12 hours did not lead to better outcomes at 90 days than usual care. (Funded by the Canadian Institutes for Health Research and Medtronic; ESCAPE-MeVO ClinicalTrials.gov number, NCT05151172.).
Details
- Title: Subtitle
- Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion
- Creators
- Mayank Goyal - University of CalgaryJohanna M Ospel - University of CalgaryAravind Ganesh - University of CalgaryDar Dowlatshahi - University of OttawaDavid Volders - Dalhousie UniversityMarkus A Möhlenbruch - University Hospital HeidelbergMouhammad A Jumaa - University of ToledoShahid M Nimjee - The Ohio State University Wexner Medical CenterThomas C Booth - King's College Hospital NHS Foundation TrustBrian H Buck - University of AlbertaJames Kennedy - Radcliffe Department of Medicine, Oxford, United KingdomJai J Shankar - University of ManitobaFranziska Dorn - University Hospital BonnLiqun Zhang - St George’s University Hospitals NHS Foundation TrustChristian Hametner - Universitätsklinikum WürzburgSandor Nardai - Semmelweis UniversityAtif Zafar - St. Michael's HospitalWilliam Diprose - University of AucklandShabnam Vatanpour - University of CalgaryAlexander Stebner - University of CalgarySalome Bosshart - University of CalgaryNishita Singh - University of ManitobaIvy Sebastian - University of CalgaryKazutaka Uchida - Hyogo UniversityKarla J Ryckborst - University of CalgaryRobert Fahed - Ottawa HospitalSherry X Hu - Dalhousie UniversityDominik F Vollherbst - Heidelberg UniversitySyed F Zaidi - University of ToledoVivien H Lee - The Ohio State University Wexner Medical CenterJeremy Lynch - King's College Hospital NHS Foundation TrustJeremy L Rempel - University of Alberta HospitalRachel Teal - Oxford University Hospitals NHS TrustAnurag Trivedi - University of ManitobaFelix J Bode - University Hospital BonnAyokunle Ogungbemi - Department of Neuroradiology, St. George's Hospital, LondonMirko Pham - Universitätsklinikum WürzburgPeter Orosz - Semmelweis UniversityMohamad Abdalkader - Boston Medical CenterChristian Taschner - University of FreiburgJason Tarpley - Little Company of Mary HospitalSven Poli - Hertie Institute for Clinical Brain ResearchRavinder-Jeet Singh - NOSM UniversityReade De Leacy - Mount Sinai Health SystemGeorge Lopez - Neuroscience InstituteDemetrios Sahlas - McMaster UniversityMichael Chen - Rush University Medical CenterPaul Burns - Royal Victoria HospitalJoanna D Schaafsma - University Health NetworkRichard Marigold - University Hospital Southampton NHS Foundation TrustArno Reich - RWTH Aachen UniversityAdewumi Amole - Baptist Health FoundationThalia S Field - University of British ColumbiaRichard H Swartz - Sunnybrook Health Science CentreFabio Settecase - Sutter HealthGábor Lenzsér - University of PecsSantiago Ortega-Gutierrez - University of Iowa Hospitals and ClinicsNegar Asdaghi - University of MiamiKyriakos Lobotesis - Imperial College Healthcare NHS TrustAdnan H Siddiqui - University at Buffalo, State University of New YorkJoerg Berrouschot - Klinikum Altenburger LandMaxim Mokin - Tampa General HospitalKoji Ebersole - University of Kansas Medical CenterHauke Schneider - University Hospital AugsburgAlbert J Yoo - Texas Stroke Institute, Dallas-Fort WorthJennifer Mandzia - Western UniversityJesse Klostranec - Montreal Neurological Institute and HospitalChangez Jadun - Royal Stoke University HospitalTufail Patankar - Leeds Teaching Hospitals NHS TrustEric Sauvageau - New England Baptist HospitalRobert Lenthall - Nottingham University Hospitals NHS TrustLissa Peeling - Royal University HospitalThien Huynh - Mayo Clinic in FloridaRonald Budzik - Riverside Methodist HospitalSeon-Kyu Lee - Montefiore Medical CenterLevansri Makalanda - Royal London HospitalMichael R Levitt - University of WashingtonRichard J Perry - University College LondonThant Hlaing - Aintree University Hospitals NHS Foundation TrustBabak S Jahromi - Northwestern UniversityPaul Singh - MedStar Georgetown University HospitalAndrew M Demchuk - University of CalgaryMichael D Hill - University of CalgaryESCAPE-MeVO Investigators
- Resource Type
- Journal article
- Publication Details
- The New England journal of medicine, Vol.392(14), pp.1385-1395
- DOI
- 10.1056/NEJMoa2411668
- PMID
- 39908448
- NLM abbreviation
- N Engl J Med
- ISSN
- 1533-4406
- eISSN
- 1533-4406
- Grant note
- 453346 / CIHR
- Language
- English
- Electronic publication date
- 02/05/2025
- Date published
- 04/10/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984786453102771
Metrics
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