1386 Mechanical Thrombectomy vs Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Study

INTRODUCTION: The management of acute ischemic stroke (AIS) due to distal medium vessel occlusion (DMVO) remains uncertain, particularly in comparing the effectiveness of Mechanical Thrombectomy (MT) versus Intravenous Thrombolysis (IVT). METHODS: This multinational study analyzed data from 37 centers across North America, Asia, and Europe. Patients with AIS due to DMVO were included, with data collected from September 2017 to July 2023. The primary outcome was functional independence, with secondary outcomes including mortality and safety measures such as types of intracerebral hemorrhage. RESULTS: The study involved 1,057 patients before matching, and 640 patients post-matching.Functional outcomes at 90 days showed no significant difference between groups in achievinggood functional recovery (mRS 0-1 and 0-2), with adjusted odds ratios (OR) of 1.21 (95% CI0.81 to 1.79; P=0.35) and 1.00 (95% CI 0.66 to 1.51; P>0.99), respectively. Mortality rates at 90days were similar between the two groups (OR 0.75, 95% CI 0.44 to 1.29; P=0.3). The incidenceof symptomatic intracerebral hemorrhage (sICH) was comparable, but any type of intracranialhemorrhage (ICH) was significantly higher in the MT-IVT group (OR 0.43, 95% CI 0.29 to 0.63;P<0.001). CONCLUSIONS: The results of this study indicate that while MT-IVT and IVT alone show similarfunctional and mortality outcomes in DMVO patients, MT-IVT presents a higher risk ofhemorrhagic complications. Further prospective randomized trials are needed to identify patientsubgroups most likely to benefit from MT-IVT treatment in DMVO.