Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion

Mayank Goyal; Johanna M. Ospel; Aravind Ganesh; Dar Dowlatshahi; David Volders; Markus A. Möhlenbruch; Mouhammad A. Jumaa; Shahid M. Nimjee; Thomas C. Booth; Brian H. Buck; James Kennedy; Jai J. Shankar; Franziska Dorn; Liqun Zhang; Christian Hametner; Sandor Nardai; Atif Zafar; William Diprose; Shabnam Vatanpour; Alexander Stebner; Salome Bosshart; Nishita Singh; Ivy Sebastian; Kazutaka Uchida; Karla J. Ryckborst; Robert Fahed; Sherry X. Hu; Dominik F. Vollherbst; Syed F. Zaidi; Vivien H. Lee; Jeremy Lynch; Jeremy L. Rempel; Rachel Teal; Anurag Trivedi; Felix J. Bode; Ayokunle Ogungbemi; Mirko Pham; Peter Orosz; Mohamad Abdalkader; Christian Taschner; Jason Tarpley; Sven Poli; Ravinder-Jeet Singh; Reade De Leacy; George Lopez; Demetrios Sahlas; Michael Chen; Paul Burns; Joanna D. Schaafsma; Richard Marigold; Arno Reich; Adewumi Amole; Thalia S. Field; Richard H. Swartz; Fabio Settecase; Gábor Lenzsér; Santiago Ortega-Gutierrez; Negar Asdaghi; Kyriakos Lobotesis; Adnan H. Siddiqui; Joerg Berrouschot; Maxim Mokin; Koji Ebersole; Hauke Schneider; Albert J. Yoo; Jennifer Mandzia; Jesse Klostranec; Changez Jadun; Tufail Patankar; Eric Sauvageau; Robert Lenthall; Lissa Peeling; Thien Huynh; Ronald Budzik; Seon-Kyu Lee; Levansri Makalanda; Michael R. Levitt; Richard J. Perry; Thant Hlaing; Babak S. Jahromi; Paul Singh; Andrew M. Demchuk; Michael D. Hill

doi:10.1056/NEJMoa2411668

Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion

Mayank Goyal, Johanna M. Ospel, Aravind Ganesh, Dar Dowlatshahi, David Volders, Markus A. Möhlenbruch, Mouhammad A. Jumaa, Shahid M. Nimjee, Thomas C. Booth, Brian H. Buck, James Kennedy, Jai J. Shankar, Franziska Dorn, Liqun Zhang, Christian Hametner, Sandor Nardai, Atif Zafar, William Diprose, Shabnam Vatanpour, Alexander StebnerSalome Bosshart, Nishita Singh, Ivy Sebastian, Kazutaka Uchida, Karla J. Ryckborst, Robert Fahed, Sherry X. Hu, Dominik F. Vollherbst, Syed F. Zaidi, Vivien H. Lee, Jeremy Lynch, Jeremy L. Rempel, Rachel Teal, Anurag Trivedi, Felix J. Bode, Ayokunle Ogungbemi, Mirko Pham, Peter Orosz, Mohamad Abdalkader, Christian Taschner, Jason Tarpley, Sven Poli, Ravinder-Jeet Singh, Reade De Leacy, George Lopez, Demetrios Sahlas, Michael Chen, Paul Burns, Joanna D. Schaafsma, Richard Marigold, Arno Reich, Adewumi Amole, Thalia S. Field, Richard H. Swartz, Fabio Settecase, Gábor Lenzsér, Santiago Ortega-Gutierrez, Negar Asdaghi, Kyriakos Lobotesis, Adnan H. Siddiqui, Joerg Berrouschot, Maxim Mokin, Koji Ebersole, Hauke Schneider, Albert J. Yoo, Jennifer Mandzia, Jesse Klostranec, Changez Jadun, Tufail Patankar, Eric Sauvageau, Robert Lenthall, Lissa Peeling, Thien Huynh, Ronald Budzik, Seon-Kyu Lee, Levansri Makalanda, Michael R. Levitt, Richard J. Perry, Thant Hlaing, Babak S. Jahromi, Paul Singh, Andrew M. Demchuk, Michael D. Hill

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Abstract

Background
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.
Methods
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.
Results
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.
Conclusions
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.)

Original language	English
Pages (from-to)	1385-1395
Number of pages	11
Journal	New England Journal of Medicine
Volume	392
Issue number	14
DOIs	https://doi.org/10.1056/NEJMoa2411668
Publication status	Published - 5 Feb 2025

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Goyal, M., Ospel, J. M., Ganesh, A., Dowlatshahi, D., Volders, D., Möhlenbruch, M. A., Jumaa, M. A., Nimjee, S. M., Booth, T. C., Buck, B. H., Kennedy, J., Shankar, J. J., Dorn, F., Zhang, L., Hametner, C., Nardai, S., Zafar, A., Diprose, W., Vatanpour, S., ... Hill, M. D. (2025). Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion. New England Journal of Medicine, 392(14), 1385-1395. https://doi.org/10.1056/NEJMoa2411668

@article{1a776d66130d4423b789bade39b3de98,

title = "Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion",

abstract = "BackgroundWhether 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.MethodsIn 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.ResultsA 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.ConclusionsEndovascular 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.)",

author = "Mayank Goyal and Ospel, {Johanna M.} and Aravind Ganesh and Dar Dowlatshahi and David Volders and M{\"o}hlenbruch, {Markus A.} and Jumaa, {Mouhammad A.} and Nimjee, {Shahid M.} and Booth, {Thomas C.} and Buck, {Brian H.} and James Kennedy and Shankar, {Jai J.} and Franziska Dorn and Liqun Zhang and Christian Hametner and Sandor Nardai and Atif Zafar and William Diprose and Shabnam Vatanpour and Alexander Stebner and Salome Bosshart and Nishita Singh and Ivy Sebastian and Kazutaka Uchida and Ryckborst, {Karla J.} and Robert Fahed and Hu, {Sherry X.} and Vollherbst, {Dominik F.} and Zaidi, {Syed F.} and Lee, {Vivien H.} and Jeremy Lynch and Rempel, {Jeremy L.} and Rachel Teal and Anurag Trivedi and Bode, {Felix J.} and Ayokunle Ogungbemi and Mirko Pham and Peter Orosz and Mohamad Abdalkader and Christian Taschner and Jason Tarpley and Sven Poli and Ravinder-Jeet Singh and {De Leacy}, Reade and George Lopez and Demetrios Sahlas and Michael Chen and Paul Burns and Schaafsma, {Joanna D.} and Richard Marigold and Arno Reich and Adewumi Amole and Field, {Thalia S.} and Swartz, {Richard H.} and Fabio Settecase and G{\'a}bor Lenzs{\'e}r and Santiago Ortega-Gutierrez and Negar Asdaghi and Kyriakos Lobotesis and Siddiqui, {Adnan H.} and Joerg Berrouschot and Maxim Mokin and Koji Ebersole and Hauke Schneider and Yoo, {Albert J.} and Jennifer Mandzia and Jesse Klostranec and Changez Jadun and Tufail Patankar and Eric Sauvageau and Robert Lenthall and Lissa Peeling and Thien Huynh and Ronald Budzik and Seon-Kyu Lee and Levansri Makalanda and Levitt, {Michael R.} and Perry, {Richard J.} and Thant Hlaing and Jahromi, {Babak S.} and Paul Singh and Demchuk, {Andrew M.} and Hill, {Michael D.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2025 Massachusetts Medical Society.",

year = "2025",

month = feb,

day = "5",

doi = "10.1056/NEJMoa2411668",

language = "English",

volume = "392",

pages = "1385--1395",

journal = "New England Journal of Medicine",

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Goyal, M, Ospel, JM, Ganesh, A, Dowlatshahi, D, Volders, D, Möhlenbruch, MA, Jumaa, MA, Nimjee, SM, Booth, TC, Buck, BH, Kennedy, J, Shankar, JJ, Dorn, F, Zhang, L, Hametner, C, Nardai, S, Zafar, A, Diprose, W, Vatanpour, S, Stebner, A, Bosshart, S, Singh, N, Sebastian, I, Uchida, K, Ryckborst, KJ, Fahed, R, Hu, SX, Vollherbst, DF, Zaidi, SF, Lee, VH, Lynch, J, Rempel, JL, Teal, R, Trivedi, A, Bode, FJ, Ogungbemi, A, Pham, M, Orosz, P, Abdalkader, M, Taschner, C, Tarpley, J, Poli, S, Singh, R-J, De Leacy, R, Lopez, G, Sahlas, D, Chen, M, Burns, P, Schaafsma, JD, Marigold, R, Reich, A, Amole, A, Field, TS, Swartz, RH, Settecase, F, Lenzsér, G, Ortega-Gutierrez, S, Asdaghi, N, Lobotesis, K, Siddiqui, AH, Berrouschot, J, Mokin, M, Ebersole, K, Schneider, H, Yoo, AJ, Mandzia, J, Klostranec, J, Jadun, C, Patankar, T, Sauvageau, E, Lenthall, R, Peeling, L, Huynh, T, Budzik, R, Lee, S-K, Makalanda, L, Levitt, MR, Perry, RJ, Hlaing, T, Jahromi, BS, Singh, P, Demchuk, AM & Hill, MD 2025, 'Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion', New England Journal of Medicine, vol. 392, no. 14, pp. 1385-1395. https://doi.org/10.1056/NEJMoa2411668

TY - JOUR

T1 - Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion

AU - Goyal, Mayank

AU - Ospel, Johanna M.

AU - Ganesh, Aravind

AU - Dowlatshahi, Dar

AU - Volders, David

AU - Möhlenbruch, Markus A.

AU - Jumaa, Mouhammad A.

AU - Nimjee, Shahid M.

AU - Booth, Thomas C.

AU - Buck, Brian H.

AU - Kennedy, James

AU - Shankar, Jai J.

AU - Dorn, Franziska

AU - Zhang, Liqun

AU - Hametner, Christian

AU - Nardai, Sandor

AU - Zafar, Atif

AU - Diprose, William

AU - Vatanpour, Shabnam

AU - Stebner, Alexander

AU - Bosshart, Salome

AU - Singh, Nishita

AU - Sebastian, Ivy

AU - Uchida, Kazutaka

AU - Ryckborst, Karla J.

AU - Fahed, Robert

AU - Hu, Sherry X.

AU - Vollherbst, Dominik F.

AU - Zaidi, Syed F.

AU - Lee, Vivien H.

AU - Lynch, Jeremy

AU - Rempel, Jeremy L.

AU - Teal, Rachel

AU - Trivedi, Anurag

AU - Bode, Felix J.

AU - Ogungbemi, Ayokunle

AU - Pham, Mirko

AU - Orosz, Peter

AU - Abdalkader, Mohamad

AU - Taschner, Christian

AU - Tarpley, Jason

AU - Poli, Sven

AU - Singh, Ravinder-Jeet

AU - De Leacy, Reade

AU - Lopez, George

AU - Sahlas, Demetrios

AU - Chen, Michael

AU - Burns, Paul

AU - Schaafsma, Joanna D.

AU - Marigold, Richard

AU - Reich, Arno

AU - Amole, Adewumi

AU - Field, Thalia S.

AU - Swartz, Richard H.

AU - Settecase, Fabio

AU - Lenzsér, Gábor

AU - Ortega-Gutierrez, Santiago

AU - Asdaghi, Negar

AU - Lobotesis, Kyriakos

AU - Siddiqui, Adnan H.

AU - Berrouschot, Joerg

AU - Mokin, Maxim

AU - Ebersole, Koji

AU - Schneider, Hauke

AU - Yoo, Albert J.

AU - Mandzia, Jennifer

AU - Klostranec, Jesse

AU - Jadun, Changez

AU - Patankar, Tufail

AU - Sauvageau, Eric

AU - Lenthall, Robert

AU - Peeling, Lissa

AU - Huynh, Thien

AU - Budzik, Ronald

AU - Lee, Seon-Kyu

AU - Makalanda, Levansri

AU - Levitt, Michael R.

AU - Perry, Richard J.

AU - Hlaing, Thant

AU - Jahromi, Babak S.

AU - Singh, Paul

AU - Demchuk, Andrew M.

AU - Hill, Michael D.

PY - 2025/2/5

Y1 - 2025/2/5

N2 - BackgroundWhether 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.MethodsIn 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.ResultsA 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.ConclusionsEndovascular 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.)

AB - BackgroundWhether 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.MethodsIn 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.ResultsA 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.ConclusionsEndovascular 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.)

UR - http://www.scopus.com/inward/record.url?scp=105003493920&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa2411668

DO - 10.1056/NEJMoa2411668

M3 - Article

SN - 0028-4793

VL - 392

SP - 1385

EP - 1395

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 14

ER -

Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion

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