Endovascular treatment for ischemic stroke due to distal medium vessel occlusions: A nationwide multicenter registry.

IF 13.3 Q1 MEDICINE, RESEARCH & EXPERIMENTAL

Med Pub Date : 2026-10-14 DOI:10.1016/j.medj.2026.101328

Changwei Guo, Jiaxing Song, Zhenxuan Tian, Chengsong Yue, Gaoming Li, Wenzhe Sun, Boyu Chen, Chong Zheng, Guoyong Zeng, Shengli Chen, Chen Gong, Xiaolei Shi, Lilan Wang, Shihai Yang, Zhongjun Chen, Xiangping Cheng, Changchun Jiang, Shuyu Jiang, Haoxuan Zhu, Jie Yang, Guojian Liu, Miao Chai, Jifei Liu, Hetai Lai, Li Wang, Quanlong Hong, Yong Liu, Weidong Huang, Mengxiu Li, Min Zhang, Weishi Chen, Peiyang Zhou, Jincheng Liu, Yuanjun Shan, Shunfu Jiang, Dahong Yang, Xu Xu, Jinfu Ma, Linyu Li, Jie Tang, Zhaoyun Guo, Shuchun Huang, Jian Wang, Zhibin Ai, Tao Xu, Liping Huang, Zhaoxia Yang, Wei Ma, Nizhen Yu, Xin Zou, Jun Luo, Xiaolin Tan, Youlin Wu, Zhuang Li, Zhouzhou Peng, Kunxin Lin, Xuanyu Chen, Linshan Wu, Linyu Zhang, Kun Luo, Yanjie Huang, Xuan Zhou, Hui Liu, Jun Wen, Hao Tang, Hanming Tu, Zhenchang Zhang, Yaoyu Tian, Jian Shen, Maojun Jiang, Yongtao Guo, Guoping Ma, Duolao Wang, Thanh Nguyen, Raul Nogueira, Mayank Goyal, Jeffrey Saver, Wenjie Zi, Chang Liu

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引用次数: 0

Abstract

Background: The effectiveness and safety of endovascular treatment (EVT) for acute ischemic stroke attributable to distal medium vessel occlusion (DMVO) remain uncertain. This study aimed to compare the effectiveness and safety of EVT plus standard medical treatment (SMT) versus SMT alone in patients with DMVO.

Methods: This nationwide multicenter registry included patients with DMVO presenting within 24 h of last known well at 116 sites in China between 2023 and 2025. The primary outcome was freedom from disability (modified Rankin Scale score of 0-1) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 h and 90-day mortality. The primary analysis was conducted using inverse probability of treatment weighting.

Findings: Among 2,524 patients, 1,564 received EVT plus SMT, and 960 received SMT alone. EVT plus SMT was associated with a higher rate of freedom from disability at 90 days compared with SMT alone (adjusted risk ratio [aRR], 1.15; 95% confidence interval [CI], 1.02-1.29; adjusted risk difference, 4.36%; 95% CI, 1.73%-6.99%). However, EVT plus SMT was associated with an increased risk of sICH (aRR, 4.03; 95% CI, 2.46-6.59). Mortality at 90 days did not differ significantly between the groups (aRR, 0.97; 95% CI, 0.81-1.16).

Conclusions: In patients with DMVO, EVT plus SMT was associated with a modestly higher rate of freedom from disability at 90 days but an increased risk of sICH.

Funding: National Natural Science Foundation of China (82425021, 82571498, and 82271349), Natural Science Foundation of Chongqing (CSTB2024NSCQ-MSX0359 and CSTB2024NSCQ-KJFZMSX0063), and Chongqing Technology Innovation and Application Development Project (CSTB2022TIAD-KPX0160).

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来源期刊

Med MEDICINE, RESEARCH & EXPERIMENTAL-

CiteScore

17.70

自引率

0.60%

发文量

102

期刊介绍： Med is a flagship medical journal published monthly by Cell Press, the global publisher of trusted and authoritative science journals including Cell, Cancer Cell, and Cell Reports Medicine. Our mission is to advance clinical research and practice by providing a communication forum for the publication of clinical trial results, innovative observations from longitudinal cohorts, and pioneering discoveries about disease mechanisms. The journal also encourages thought-leadership discussions among biomedical researchers, physicians, and other health scientists and stakeholders. Our goal is to improve health worldwide sustainably and ethically. Med publishes rigorously vetted original research and cutting-edge review and perspective articles on critical health issues globally and regionally. Our research section covers clinical case reports, first-in-human studies, large-scale clinical trials, population-based studies, as well as translational research work with the potential to change the course of medical research and improve clinical practice.