ASA: Mechanical Removal of Clot No Better Than Best Medical Treatment for Medium or Distal Vessel Occlusion
MONDAY, Feb. 10, 2025 -- Endovascular thrombectomy (EVT) does not lead to better outcomes at 90 days compared with usual care or best medical treatment for patients with acute ischemic stroke due to medium vessel occlusion, according to two studies published online Feb. 5 in the New England Journal of Medicine to coincide with the annual American Stroke Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.
Mayank Goyal, M.D., Ph.D., from the University of Calgary Cumming School of Medicine in Alberta, Canada, and colleagues randomly assigned patients with acute ischemic stroke due to medium vessel occlusion to receive EVT plus usual care or usual care alone (255 and 275 patients, respectively). The researchers found that a modified Rankin scale score of 0 or 1 at 90 days occurred in 41.6 and 43.1 percent of patients in the EVT and usual care groups, respectively (adjusted rate ratio, 0.95; 95 percent confidence interval, 0.79 to 1.15; P = 0.61). Mortality at 90 days was higher in the EVT group (13.3 versus 8.4 percent; adjusted hazard ratio, 1.82; 95 percent confidence interval, 1.06 to 3.12).
Marios Psychogios, M.D., from University Hospital Basel in Switzerland, and colleagues randomly assigned participants with an isolated occlusion of medium or distal vessels to receive EVT plus best medical treatment or best medical treatment alone (271 and 272 patients, respectively). The researchers observed no significant difference in the distribution of modified Rankin scale scores at 90 days in the comparison between EVT plus best medical treatment versus best medical treatment alone. The two groups had similar all-cause mortality and incidence of symptomatic intracranial hemorrhage.
"Identification of persons who might benefit from EVT on the basis of imaging selection and potentially improved techniques or materials should be investigated in future randomized trials," Psychogios and colleagues write.
Several authors from both studies and the author of the editorial disclosed ties to the biopharmaceutical and medical device industries.
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