Endovascular Treatment of Medium-Vessel-Occlusion Strokes

BACKGROUND: Endovascular thrombectomy for acute ischemic stroke due to medium-vessel occlusion has had varying results across trials. Whether thrombectomy improves functional outcomes in patients with medium-vessel occlusion and moderate-to-severe deficits is unclear. METHODS: We conducted an open-label, randomized trial with blinded outcome assessment at 48 centers in China. Eligible patients were adults who presented within 24 hours after the onset of a moderate-to-severe stroke (National Institutes of Health Stroke Scale [NIHSS] score, ≥6; scale, 0 to 42, with higher scores indicating greater neurologic deficits) due to occlusion of a medium vessel. Patients were assigned in a 1:1 ratio to thrombectomy plus medical management (thrombectomy group) or medical management alone (control group). The primary outcome was functional disability as measured by the shift in the modified Rankin scale score (scale, 0 [no disability] to 6 [death]) at 90 days. Violation of the proportional-odds assumption precluded the use of shift in the modified Rankin scale score, so as prespecified, functional independence (modified Rankin scale score of 0, 1, or 2) at 90 days was used as the primary outcome. Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality. RESULTS: Among 280 patients in the thrombectomy group and 283 in the control group, the median age was 71 years, the median NIHSS score was 10 (range, 3 to 36), and 42.8% were women; 36.6% received intravenous thrombolysis. Functional independence at 90 days was seen in 58.6% of the patients in the thrombectomy group and in 46.6% of those in the control group (adjusted rate ratio, 1.24; 95% confidence interval, 1.07 to 1.44; P = 0.004). The incidence of symptomatic intracranial hemorrhage was 4.7% in the thrombectomy group and 2.2% in the control group; 90-day mortality was 11.1% and 10.2%, respectively. CONCLUSIONS: Among patients with acute ischemic stroke due to medium-vessel occlusion and moderate-to-severe deficits, thrombectomy led to a greater likelihood of functional independence than medical management alone but also to a higher risk of symptomatic intracranial hemorrhage. (Funded by the National Natural Science Foundation of China and the Noncommunicable Chronic Diseases-National Science and Technology Major Project; ORIENTAL-MeVO ClinicalTrials.gov number, NCT06146790.).

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Publication Details

Journal
New England Journal of Medicine
Published
2026-05-13
DOI
https://doi.org/10.1056/nejmoa2514120
Citations
1
Primary Topic
Acute Ischemic Stroke Management
Type
article
Field-Weighted Citation Impact
18.09

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article

Endovascular Treatment of Medium-Vessel-Occlusion Strokes

Lin Tong, Shunfu Jiang, J F Sun, Jianlong Song et al.
1 citations
New England Journal of Medicine
Acute Ischemic Stroke Management
18.09
article

Endovascular Treatment of Medium-Vessel-Occlusion Strokes

Lin Tong, Shunfu Jiang, J F Sun, Jianlong Song, Y C Zhu, T Liu, Z J Chen, R K Li, Youquan Ren, Junzhong Liu, Changchun Jiang, Zhongfan Ruan, Jin Zheng, Lei Yang, Tao Cui, Yi-Xiang Wang, Yong Liang, Tuanyuan Zheng, Cunfeng Song, Jianshang Wen, Wenhuo Chen, Tingyu Yi, Xiaozhong Jing, Ganghua Feng, Z H Li, Liqi Shu, Tao Wang, Raul G. Nogueira, Pengfei Xu, Xiaofan Guo, Wei Hu, Chao Zhang, Yong Liu, Chong Zheng, Hao Wang, Anmo Wang, Shouchun Wang, Tao Qiu, Jeffrey L. Saver, Mohamad AbdalKader, Adnan I. Qureshi, Zhengfei Ma, Bin Mei, Li Wang, ˒Peiyang Zhou, Yun Luo, Chunrong Tao, Thanh N. Nguyen, Zhiming Zhou
article en
1 citations

Abstract

BACKGROUND: Endovascular thrombectomy for acute ischemic stroke due to medium-vessel occlusion has had varying results across trials. Whether thrombectomy improves functional outcomes in patients with medium-vessel occlusion and moderate-to-severe deficits is unclear. METHODS: We conducted an open-label, randomized trial with blinded outcome assessment at 48 centers in China. Eligible patients were adults who presented within 24 hours after the onset of a moderate-to-severe stroke (National Institutes of Health Stroke Scale [NIHSS] score, ≥6; scale, 0 to 42, with higher scores indicating greater neurologic deficits) due to occlusion of a medium vessel. Patients were assigned in a 1:1 ratio to thrombectomy plus medical management (thrombectomy group) or medical management alone (control group). The primary outcome was functional disability as measured by the shift in the modified Rankin scale score (scale, 0 [no disability] to 6 [death]) at 90 days. Violation of the proportional-odds assumption precluded the use of shift in the modified Rankin scale score, so as prespecified, functional independence (modified Rankin scale score of 0, 1, or 2) at 90 days was used as the primary outcome. Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality. RESULTS: Among 280 patients in the thrombectomy group and 283 in the control group, the median age was 71 years, the median NIHSS score was 10 (range, 3 to 36), and 42.8% were women; 36.6% received intravenous thrombolysis. Functional independence at 90 days was seen in 58.6% of the patients in the thrombectomy group and in 46.6% of those in the control group (adjusted rate ratio, 1.24; 95% confidence interval, 1.07 to 1.44; P = 0.004). The incidence of symptomatic intracranial hemorrhage was 4.7% in the thrombectomy group and 2.2% in the control group; 90-day mortality was 11.1% and 10.2%, respectively. CONCLUSIONS: Among patients with acute ischemic stroke due to medium-vessel occlusion and moderate-to-severe deficits, thrombectomy led to a greater likelihood of functional independence than medical management alone but also to a higher risk of symptomatic intracranial hemorrhage. (Funded by the National Natural Science Foundation of China and the Noncommunicable Chronic Diseases-National Science and Technology Major Project; ORIENTAL-MeVO ClinicalTrials.gov number, NCT06146790.).

New England Journal of MedicineVol. 394(19)
Wannan Medical College (CN), University of Science and Technology of China (CN), Hubei University of Medicine (CN), Boston Medical Center (US), Fujian Medical University (CN), University of California, Los Angeles (US), University of Pittsburgh (US), Anhui University of Science and Technology (CN), Jilin University (CN), Wuhan University (CN), Fuyang City People's Hospital (CN), Huaian First People’s Hospital (CN), Linyi People's Hospital (CN), UPMC Health System (US), Jiujiang First People's Hospital (CN), Jingdezhen University (CN), Zhangzhou Municipal Hospital of Fujian Province (CN), Dalian Municipal Central Hospital (CN), Rehabilitation Institute of Kansas City (US), Nanjing Drum Tower Hospital (CN), Suzhou Municipal Hospital (CN), Xiangyang Central Hospital (CN), Zoucheng People's Hospital (CN), Zhongnan Hospital of Wuhan University (CN), First Affiliated Hospital of Fujian Medical University (CN), First Hospital of Jilin University (CN), Baotou Central Hospital (CN), Zhengzhou Central Hospital (CN), University of Pittsburgh Medical Center (US), Central Hospital of Putuo District (CN), First Affiliated Hospital of University of South China (CN), Obstetrics and Gynecology Hospital of Fudan University (CN), Chenzhou First People's Hospital (CN), Hengyang Academy of Agricultural Sciences (CN), Zigong First People's Hospital (CN), Union Hospital (US), Liaocheng People's Hospital (CN), Beijing Fengtai Hospital (CN), Union Hospital (CN), Anshan Hospital (CN), Lu'an First People's Hospital (CN), First Affiliated Hospital of Wannan Medical College (CN), University of Missouri (US), University of South China (CN)
National Natural Science Foundation of China
Good health and well-being
Openalex Percentile: Top 1%
Acute Ischemic Stroke Management
18.09
DOISourceOpenAlex
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