Mechanical Thrombectomy in Ischemic Stroke With a Medium or Distal Arterial Occlusion

Does mechanical thrombectomy improve the rate of good clinical outcome in patients with acute ischemic stroke related to a primary and isolated medium or distal vessel occlusion? In this randomized clinical trial that included 244 participants, the rate of good clinical outcome (modified Rankin Scale score 0-2) at 3 months was 62% in the thrombectomy group and 68% in the medical treatment–alone group, a difference that was not statistically significant. The rate of symptomatic hemorrhage was more than 3 times higher with thrombectomy than with medical treatment alone (11% vs 3%). In patients with acute ischemic stroke related to a medium or distal vessel occlusion, thrombectomy did not improve clinical outcomes and was associated with an increased risk of hemorrhage, which does not support its routine use in this setting.

Corresponding Author: Frédéric Clarençon, MD, PhD, Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Bd de l’Hôpital, 75013 Paris, France (frederic.clarencon@aphp.fr).

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