{
  "abstract": "Introduction Approximately 25% to 40% of acute ischemic strokes (AIS) are attributable to distal medium vessel occlusions (DMVOs). Endovascular therapy (EVT) has the potential to recanalize these patients and improve patient outcomes, but recent evidence has carried mixed results on safety and efficacy. This meta-analysis synthesizes evidence from all five recent randomised controlled trials (RCTs) comparing EVT to best medical therapy (BMT) for AIS due to DMVOs.Methodology A systematic literature review of EVT for DMVO RCTs compared to BMT published by March 2026 was conducted using PubMed on the Nested Knowledge platform. Data was extracted on clinical and safety outcomes. The primary outcome was a comparison of good functional outcome defined as mRS 0-2 at 90 days. Other outcomes assessed were mortality, symptomatic intracranial haemorrhage (sICH), serious adverse events (SAEs) and subarachnoid haemorrhage (SAH). R-Studio was used to perform a meta-analysis using random-effects model. All comparisons were calculated using odds ratio (OR) with 95% confidence intervals.Results The initial search yielded 324 articles, of which 5 met the inclusion criteria, representing 1,894 patients with DMVOs (923 patients receiving EVT and 971 receiving BMT). EVT did not improve good functional outcomes (OR 1.07 [95% CI: 0.88 to 1.29]) nor mortality (OR 1.2 [95% CI: 0.90 to 1.61]). However, safety outcomes were increased due to EVT with higher sICH (OR 2.35 [95% CI: 1.45 to 3.83]), higher SAEs (OR 1.49 [95% CI: 1.17 to 1.89]) and higher SAH (OR 13.06 [95% CI: 6.24 to 27.37]) (figure 1). Heterogeneity was considerably high for mRS outcomes with 2 RCTs showing positive and 2 RCTs showing negative results, but low for all other outcomes.Conclusions In the DMVO population studied by all 5 recent RCTs, EVT does not provide a clinical benefit compared to BMT. On the other hand, there is a consistently higher risk of hemorrhagic complications (sICH and SAH) and SAEs due to EVT. Further sub -analyses will help understand the populations with a better risk/reward ratio.Disclosures M. Mirza: None. N. Moreton: None. M. Perez: None. C. Ulfert: None. P. Brouwer: None.",
  "authors": [
    {
      "affiliations": [
        "Johnson & Johnson MedTech Neurovascular, Galway, IRELAND"
      ],
      "name": "M Mirza"
    },
    {
      "affiliations": [
        "Johnson & Johnson MedTech Neurovascular, Galway, IRELAND"
      ],
      "name": "N Moreton"
    },
    {
      "affiliations": [
        "Johnson & Johnson MedTech Neurovascular, Galway, IRELAND"
      ],
      "name": "M Perez"
    },
    {
      "affiliations": [
        "Neurosurgery & Radiology, Mount Sinai, New York, NY"
      ],
      "name": "R De Leacy"
    },
    {
      "affiliations": [
        "Johnson & Johnson MedTech Neurovascular, Galway, IRELAND"
      ],
      "name": "C Ulfert"
    },
    {
      "affiliations": [
        "Johnson & Johnson MedTech Neurovascular, Galway, IRELAND"
      ],
      "name": "P Brouwer"
    }
  ],
  "title": "E-010 Mechanical thrombectomy for distal medium vessel occlusions causing acute ischemic stroke: a meta-analysis of five randomised controlled trials",
  "uid": "34b2daa2-bd55-51fa-9bcf-e999d1b77323"
}