{
  "abstract": "Abstract Background Randomized trials have not shown a clear benefit of endovascular therapy (EVT) for medium vessel occlusion (MeVO) strokes. We aimed to identify subgroups in which successful recanalization provides meaningful clinical benefit.Methods We retrospectively analyzed prospectively recorded consecutive patients with MeVO stroke treated with EVT at two comprehensive stroke centers. Successful recanalization was defined as expanded Thrombolysis in Cerebral Infarction (eTICI) 2b–3. The treatment effect was calculated as the difference in 90-day functional independence (modified Rankin Scale score 0–2) between recanalized and non-recanalized patients. Predicted infarct core on admission was calculated on non-contrast CT using AI-based software (AI-ICV; Methinks AI) and on CT perfusion (cerebral blood flow (CBF) <30%; IschemiaView). The hypoperfused volume (Tmax >6 s) was also obtained and the perfusion mismatch ratio was calculated (Tmax >6 s – CBF <30%)/Tmax >6 s). The treatment effect was analyzed in the overall cohort and after applying enrichment strategies based on clinical and imaging variables. Optimal cutoffs were identified by maximizing the added treatment effect while retaining ≥40% of the cohort.Results Among 232 EVT-treated patients (mean age 76.1±12.3 years; median (IQR) National Institutes of Health Stroke Scale (NIHSS) score 9 (6–14)), the recanalization rate was 84.9%. The overall treatment effect was +33.3% (recanalized 53.3% vs non-recanalized 20.0%). Enrichment strategies increased the treatment effect: age ≤80 years (+13.8%), AI-ICV ≤9 mL (+9.9%), and NIHSS score ≥10 (+6.7%). Combining age, NIHSS, and AI-ICV criteria increased the treatment effect to 61.9% for an added value of +33.6%.Conclusions In MeVO stroke, the benefit of successful recanalization is substantial and can be further enhanced through pragmatic enrichment using readily available clinical and imaging variables, supporting refined patient selection and future trial design focused on enriched subgroups.",
  "authors": [
    {
      "affiliations": [
        "Stroke Unit, Vall d’Hebron Research Institute, Barcelona, Spain"
      ],
      "name": "Judith Cendrero"
    },
    {
      "affiliations": [
        "University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Anderson Brito"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Manuel Requena"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Eric Kontowicz"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Alejandro Tomasello"
    },
    {
      "affiliations": [
        "Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Marc Rodrigo-Gisbert"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Francesco Diana"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Marta de Dios Lascuevas"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "David Hernandez"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Leonardo Cruz-Criollo"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Nashwa Abdelhakim"
    },
    {
      "affiliations": [
        "Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Ane Murillo"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Iowa Health Care, Iowa City, Iowa, USA"
      ],
      "name": "Jorge Cespedes"
    },
    {
      "affiliations": [
        "Methinks, Barcelona, Spain"
      ],
      "name": "Victor Salvia"
    },
    {
      "affiliations": [
        "Methinks, Barcelona, Spain"
      ],
      "name": "Leonardo Tanzi"
    },
    {
      "affiliations": [
        "Stroke Unit, Vall d’Hebron Research Institute, Barcelona, Spain"
      ],
      "name": "Magda Jablonska"
    },
    {
      "affiliations": [
        "Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA"
      ],
      "name": "Santiago Ortega-Gutierrez"
    },
    {
      "affiliations": [
        "Stroke Unit, Vall d’Hebron Research Institute, Barcelona, Spain",
        "Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain",
        "Stroke Unit, Neurology, Hospital Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Marc Ribo"
    }
  ],
  "title": "Refining thrombectomy benefit in medium vessel occlusion (MeVO) strokes using imaging and clinical enrichment",
  "uid": "d5f15120-8681-540c-bc8d-44492da7aaf5"
}