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TOPLINE:

Endovascular thrombectomy combined with medical management was associated with improved functional independence compared with medical management alone in patients with acute ischemic stroke due to medium-vessel occlusion and moderate-to-severe deficits, a new trial reported. The findings were first covered by Medscape Medical News at the International Stroke Conference (ISC) 2026.

METHODOLOGY:

• Researchers conducted a prospective, open-label, randomized controlled trial with blinded outcome assessment in China from 2023 to 2025, including 564 adults with acute ischemic stroke due to medium-vessel occlusion (median age, 71 years; 43% female) who presented within 24 hours after symptom onset and moderate-to-severe clinical deficits (baseline score of 6 or more on the National Institutes of Health Stroke Scale ).
• The patients were randomly assigned to receive endovascular thrombectomy plus medical management (thrombectomy group; n = 281) or medical management alone (control group; n = 283).
• The primary outcome was a change in functional disability at 90 days, assessed using modified Rankin Scale (mRS) scores via structured telephone interviews with patients or caregivers.
• Secondary outcomes included the achievement of functional independence (mRS score of 0, 1, or 2) and an excellent outcome (mRS score of 0 or 1). Safety outcomes were improvements in symptomatic intracranial hemorrhage and 90-day mortality.

TAKEAWAY:

• Functional independence at 90 days was achieved by 59% of the thrombectomy group vs 47% of the control group (adjusted rate ratio [aRR], 1.24; P = .004).
• An excellent outcome at 90 days was more common with thrombectomy (49% vs 33%; aRR, 1.47; 95% CI, 1.20-1.78).
• Symptomatic intracranial hemorrhages at 24-72 hours occurred in 5% of the thrombectomy group vs 2% of the control group (aRR, 2.21; 95% CI, 0.87-5.63).
• Mortality at 90 days was 11% in the thrombectomy group and 10% in the control group (aRR, 1.11; 95% CI, 0.70-1.76).

IN PRACTICE:

According to the authors of an accompanying editorial, “Some patients with stroke due to medium-vessel occlusion — specifically those with a younger age, higher stroke severity, and early presentation who are not sequentially or concurrently treated with thrombolysis — will be most likely to benefit from endovascular thrombectomy.”

SOURCE:

The study was co-led by Wei Hu, MD, and Xiaozhong Jing, MD, of the University of Science and Technology of China, Hefei, China; Zhongjun Chen, MD, Central Hospital of Dalian University of Technology (Dalian Municipal Central Hospital), Dalian, China; Jin Zheng, MD, Fudan University, Shanghai, China; Wenhuo Chen, MD, Fujian Medical University Union Hospital, Fuzhou, China; and Raul G. Nogueira, MD, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh. The accompanying editorial was led by Johanna M. Ospel, MD, Cumming School of Medicine, University of Calgary and Foothills Medical Centre, Calgary, Alberta, Canada. Both articles were published online on May 13 in The New England Journal of Medicine.

LIMITATIONS:

A small proportion of patients in the study received intravenous thrombolysis, which may have affected the observed effects of therapy. Patients with mild deficits were not included. Functional independence was determined using telephone interviews and patient or caregiver reports, which may have led to a misclassification bias. Patients with large infarctions were excluded owing to imaging criteria, which may have limited the generalizability of the results. 

DISCLOSURES:

The study was funded by the National Natural Science Foundation of China and the Noncommunicable Chronic Diseases — National Science and Technology Major Project. Disclosure data for the study investigators and the authors of the accompanying editorial are available in the respective original articles.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.