[en] [en] BACKGROUND: Endovascular treatment (EVT) of stroke with large-vessel occlusion is known to be safe and effective. The effect of EVT for occlusion of medium or distal vessels is unclear.
METHODS: We randomly assigned participants with an isolated occlusion of medium or distal vessels (occlusion of the nondominant or codominant M2 segment of the middle cerebral artery [MCA]; the M3 or M4 segment of the MCA; the A1, A2, or A3 segment of the anterior cerebral artery; or the P1, P2, or P3 segment of the posterior cerebral artery) to receive EVT plus best medical treatment or best medical treatment alone within 24 hours after the participant was last seen to be well. The primary outcome was the level of disability at 90 days, as assessed with the modified Rankin scale score.
RESULTS: A total of 543 participants (women, 44%; median age, 77 years) were included in the analysis: 271 were assigned to receive EVT plus best medical treatment and 272 to receive best medical treatment alone. The median score on the National Institutes of Health Stroke Scale (range, 0 to 42, with higher scores indicating more severe symptoms) at admission was 6 (interquartile range, 5 to 9). Intravenous thrombolysis was given to 65.4% of the participants. The predominant occlusion locations were the M2 segment (in 44.0% of the participants), M3 segment (in 26.9%), P2 segment (in 13.4%), and P1 segment (in 5.5%). In the comparison between EVT plus best medical treatment and best medical treatment alone, no significant difference in the distribution of modified Rankin scale scores was observed at 90 days (common odds ratio for improvement in the score, 0.90; 95% confidence interval, 0.67 to 1.22; P = 0.50). All-cause mortality was similar in the two groups (15.5% with EVT plus best medical treatment and 14.0% with best medical treatment alone), as was the incidence of symptomatic intracranial hemorrhage (5.9% and 2.6%, respectively).
CONCLUSIONS: In persons with stroke with occlusion of medium or distal vessels, EVT did not result in a lower level of disability or a lower incidence of death than best medical treatment alone. (Funded by the Swiss National Science Foundation and others; DISTAL ClinicalTrials.gov number, NCT05029414.).
Disciplines :
Neurology
Author, co-author :
Psychogios, Marios ; Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland ; University of Basel, Basel, Switzerland
Brehm, Alex; Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
Ribo, Marc ; Department of Neurology, Hospital Vall d'Hebron, Barcelona ; Universitat Autònoma de Barcelona, Barcelona
Rizzo, Federica; Department of Neurology, Hospital Vall d'Hebron, Barcelona ; Universitat Autònoma de Barcelona, Barcelona
Strbian, Daniel; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki
Räty, Silja; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki
Arenillas, Juan F; Department of Neurology, Stroke Program and Clinical Neurosciences Research Group, Department of Medicine, University Hospital Valladolid, Valladolid, Spain ; Department of Neurology, Stroke Program, University Hospital Valladolid, Valladolid, Spain
Martínez-Galdámez, Mario; Interventional Neuroradiology Unit, Department of Radiology, University Hospital Valladolid, Valladolid, Spain
Hajdu, Steven D; Department of Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Michel, Patrik; Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Gralla, Jan; Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
Piechowiak, Eike I; Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
Kaiser, Daniel P O; Institute of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany ; Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Puetz, Volker; Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany ; Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Van den Bergh, Frans; Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels
De Raedt, Sylvie; Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Neuroprotection and Neuromodulation Research Group, Vrije Universiteit Brussel, Brussels
Bellante, Flavio; Department of Neurology, Hôpital Civil Marie Curie, Centre Hospitalier Universitaire Charleroi, Charleroi, Belgium
Dusart, Anne; Department of Neurology, Hôpital Civil Marie Curie, Centre Hospitalier Universitaire Charleroi, Charleroi, Belgium
Hellstern, Victoria; Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
Khanafer, Ali; Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
Parrilla, Guillermo; Department of Neurology, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
Morales, Ana; Department of Neurology, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain
Kirschke, Jan S; Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, School of Medicine and Health, Klinikum Rechts der Isar, Munich, Germany
Wunderlich, Silke; Department of Neurology, Technical University of Munich, School of Medicine and Health, Klinikum Rechts der Isar, Munich, Germany
Fiehler, Jens; Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Thomalla, Götz ; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Lemmens, Robin; Department of Neurosciences, Experimental Neurology, KU Leuven, and Department of Neurology, University Hospitals Leuven - both in Leuven, Belgium
Peluso, Jo P; Department of Interventional Neuroradiology, University Hospital Leuven, Leuven, Belgium
Bolognese, Manuel; Neurocenter, Cantonal Hospital of Lucerne, Lucerne, Switzerland
von Hessling, Alexander; Section of Neuroradiology, Neurocenter, Cantonal Hospital of Lucerne, Lucerne, Switzerland
van Es, Adriaan; Department of Radiology, Leiden University Medical Center, and University Neurovascular Center Leiden-the Hague - both in Leiden, the Netherlands
Kruyt, Nyika D; Department of Neurology, Leiden University Medical Center, and University Neurovascular Center Leiden-the Hague - both in Leiden, the Netherlands
Coutinho, Jonathan M; Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam
Castaño, Carlos; Department of Interventional Neuroradiology, University Hospital Germans Trias i Pujol, Badalona, Spain
Minnerup, Jens; Department of Neurology, University of Münster, Münster, Germany ; Department of Neurology, University of Lübeck, Lübeck, Germany
van Zwam, Wim; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
Dhondt, Elisabeth; Department of Vascular and Interventional Neuro-Radiology, Ghent University Hospital, Ghent, Belgium
Nolte, Christian H; Department of Neurology with Experimental Neurology and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin
Machi, Paolo; Division of Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva
Loehr, Christian; Department of Neuroradiology, Klinikum Vest, Recklinghausen, Germany
Mattle, Heinrich P; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland
Buhk, Jan-Hendrik; Department of Neuroradiology, Asklepios Hospital St. Georg, Hamburg, Germany
Kaesmacher, Johannes; Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland ; Diagnostic and Interventional Neuroradiology, Clinical Investigation Center for Innovative Technology 1415, Centre Hospitalier Régional Universitaire de Tours, Tours, France
Dobrocky, Tomas; Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, Bern, Switzerland
Papanagiotou, Panagiotis; Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte, Bremen, Germany ; Department of Radiology, Areteion University Hospital, National and Kapodistrian University of Athens, Athens
Alonso, Angelika; Department of Neurology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
Holtmannspoetter, Markus; Department of Diagnostic and Interventional Neuroradiology, Hospital Nuremberg-South Campus, Nuremberg, Germany
Zini, Andrea; IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
Renieri, Leonardo; Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy
Keil, Fee; Institution of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
van den Wijngaard, Ido; Department of Neurology, Leiden University Medical Center, and University Neurovascular Center Leiden-the Hague - both in Leiden, the Netherlands ; Department of Neurology and Radiology, Haaglanden Medical Center, Den Haag, the Netherlands
Kägi, Georg; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland ; Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
Terceño, Mikel; Department of Neurology, Hospital Doctor Josep Trueta, Girona, Spain
Wiesmann, Martin; Department of Diagnostic and Interventional Neuroradiology, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
Amaro, Sergio; Department of Neurology, Hospital Clinic Barcelona, Barcelona
Rommers, Nikki; Department of Clinical Research, University Hospital Basel, Basel, Switzerland
Balmer, Luzia; Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland
Fragata, Isabel; Department of Neuroradiology, Central University Hospital Lisboa, Lisbon, Portugal
Katan, Mira; Department of Neurology, University Hospital Basel, Basel, Switzerland
Leker, Ronen R; Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Saver, Jeffrey L ; Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
Staals, Julie; Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
Fischer, Urs; Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland ; Department of Neurology, University Hospital Basel, Basel, Switzerland
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Université de Liège - ULiège > GIGA > GIGA Metabolism & Cardiovascular Biology - Cardiology ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques ; Centre Hospitalier Universitaire de Liège - CHU > > Service de neurologie
Language :
English
Title :
Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels.
Gottfried und Julia Bangerter-Rhyner-Stiftung SNF - Schweizerischer Nationalfonds zur Förderung der wissenschaftlichen Forschung Medtronic
Funding text :
Supported by the Swiss National Science Foundation, Gottfried und Julia Bangerter-Rhyner-Stiftung, Medtronic, Stryker Neurovascular, Phenox, Rapid Medical, and Penumbra. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
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