Endovascular thrombectomy for stroke due to medium vessel occlusion: a meta-analysis of randomized controlled trials

Background: Medium vessel occlusion (MeVO) strokes are a unique subgroup with potentially debilitating results, with limited literature on treatment options. This meta-analysis assesses the efficacy of endovascular thrombectomy (EVT) in MeVO stroke. Methods: Science Direct, PubMed, and The Cochrane Library were searched for randomized controlled trials from 2010 to 2025. All studies included MeVO stroke patients aged ≥18 years, NIHSS ≥5, and those undergoing EVT. Endpoints included modified Rankin Scale (mRS) score (0–1), symptomatic intracranial hemorrhage (SICH), and mortality. ROB2 was used to assess the quality of studies, and risk ratios (RRs) were calculated. The protocol was registered on PROSPERO. Results: Only four trials were included from the original 5912 articles retrieved. Results showed mRS score improvement with EVT [RR 1.09; 95% confidence interval (CI) 0.84–1.42; P = 0.54], while showing a minor increase in SICH with EVT (RR 1.54; 95% CI 0.48–5.00; P = 0.47). No difference was observed in mortality between the two groups (RR 1.00; 95% CI 0.55–1.79; P = 0.99). None of the results were statistically significant. Conclusion: Endovascular therapy showed no significant benefit in MeVO stroke; however, existing data are inconclusive and require further research.