Endovascular Thrombectomy versus Standard Care For Strokes Involving Medium or Distal Vessel Occlusions: A Systematic Review and Meta-Analysis.

Abstract

Medium and distal vessel occlusions (MeVO/DVO) contribute to significant stroke-related disability, yet their optimal management remains unclear. While endovascular thrombectomy (EVT) is standard for large vessel occlusions, its role in MeVO/DVO strokes is still being evaluated. We conducted a systematic review and meta-analysis of randomized controlled trials comparing EVT to standard medical therapy for MeVO/DVO strokes. Databases included PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials (through March 2025). We screened a total of 2,237 records and included 4 randomized controlled trials in the final analysis. Outcomes included mortality, symptomatic intracranial hemorrhage, and functional independence (modified Rankin Scale scores at 3 months). Data from 1,254 patients (627 EVT, 627 standard care) were analyzed. EVT did not significantly reduce mortality or symptomatic intracranial hemorrhage, nor did it improve good functional outcomes (modified Rankin scale 0-1 or 0-2). Sensitivity analysis excluding specific trials (e.g., ESCAPE-MeVO) suggested potential benefits for functional independence. EVT did not demonstrate significant overall benefit over standard therapy in MeVO/DVO strokes. Further studies are needed to clarify its role in selecting patient subgroups and evolving treatment contexts.