Acute Management of Medium Vessel Occlusion Stroke: New Evidence and a Path Forward
Acute stroke due to medium vessel occlusion (MeVO) accounts for 25% to 40% of all acute ischemic stroke cases and is associated with substantial morbidity despite current best medical management. This motivated several recently published and ongoing trials that investigate(d) the benefit of endovascular thrombectomy (EVT) for MeVO stroke. Two of these trials have been published, an interim analysis of a third has been presented, and a fourth will be presented soon. The available trial results suggest no difference in outcomes between EVT and best medical management, and a possibility of harm with EVT. Preliminary post hoc analyses have however identified promising patient subgroups that may derive benefit from EVT. Improving EVT tools and techniques, together with adjunctive treatments, may further increase the technical efficacy of MeVO EVT. This review summarizes clinical and imaging features of MeVO stroke, reviews current evidence for medical and endovascular treatment, discusses recent MeVO EVT trial results, and outlines possible pathways forward for future MeVO trials.
Authors
- Urs Fischer (ORCID: https://orcid.org/0000-0003-0521-4051)
- Umberto Pensato (ORCID: https://orcid.org/0000-0002-4042-4735)
- Bernard Yan (ORCID: https://orcid.org/0000-0001-8802-9606)
- Johanna Maria Ospel (ORCID: https://orcid.org/0000-0003-0029-6764)
- Mohammed Almekhlafi (ORCID: https://orcid.org/0000-0001-9550-8197)
- Thanh N. Nguyen (ORCID: https://orcid.org/0000-0002-2810-1685)
- Frédéric Clarençon (ORCID: https://orcid.org/0000-0002-6442-8239)
- Marios‐Nikos Psychogios (ORCID: https://orcid.org/0000-0002-0016-414X)
- René Chapot (ORCID: https://orcid.org/0000-0002-2584-8361)
- Shinichi Yoshimura (ORCID: https://orcid.org/0000-0002-3600-4842)
- William K. Diprose (ORCID: https://orcid.org/0000-0002-3808-4428)
- Mayank Goyal (ORCID: https://orcid.org/0000-0001-9060-2109)
- Bijoy K. Menon (ORCID: https://orcid.org/0000-0002-3466-496X)
- Wei Hu (ORCID: https://orcid.org/0000-0002-4826-4633)
- Michael D. Hill (ORCID: https://orcid.org/0000-0002-6269-1543)
- Kazutaka Uchida (ORCID: https://orcid.org/0000-0003-4780-9598)
Institutions
- University of Science and Technology of China (CN)
- Tufts Medical Center (US)
- The Royal Melbourne Hospital (AU)
- Humanitas University (IT)
- University of Auckland (NZ)
- John Hunter Hospital (AU)
- University Hospital of Bern (CH)
- Foothills Medical Centre (CA)
- University Hospital of Basel (CH)
- Sorbonne Université (FR)
- Pitié-Salpêtrière Hospital (FR)
- Alfried Krupp Hospital (DE)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Hunter New England Local Health District (AU)
- IRCCS Humanitas Research Hospital (IT)
- Hyogo University (JP)
Publication Details
- Journal
- Stroke
- Published
- 2025-11-14
- DOI
- https://doi.org/10.1161/strokeaha.125.050401
- Citations
- 2
- Primary Topic
- Acute Ischemic Stroke Management
- Type
- article
- Field-Weighted Citation Impact
- 2.71