A182 Mechanical thrombectomy for distal medium vessel occlusions causing acute ischemic stroke: a meta-analysis of five randomised controlled trials

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Background/Introduction Distal medium vessel occlusions (DMVOs) account for ~25–40% of acute ischemic strokes. While endovascular therapy (EVT) may improve outcomes, recent trials show mixed safety and efficacy. Objective/Purpose This meta-analysis synthesizes evidence from five randomized controlled trials comparing EVT with best medical therapy for DMVO-related stroke. Methods/Case Description A systematic literature review of EVT for DMVO RCTs compared to BMT published by April 2026 was conducted using PubMed on the Nested Knowledge platform. The primary outcome was a comparison of good functional outcome (mRS 0-2 at 90 days). Other outcomes assessed were mortality, symptomatic intracranial haemorrhage (sICH), serious adverse events (SAEs) and subarachnoid haemorrhage (SAH). A random-effects meta-analysis was performed in RStudio, reporting odds ratios with 95% confidence intervals. Results/Findings The 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 mRS 0-2 at 90 days (OR 0.96 [95% CI: 0.60 to 1.53]) nor mortality (OR 1.21 [95% CI: 0.90 to 1.62]). EVT was associated 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 13.07 [95% CI: 6.24 to 27.37]) (figure 1) Discussion/Conclusions/Learning Points Across five recent RCTs in DMVO-related stroke, EVT shows no clinical benefit over best medical therapy and is associated with a higher risk of sICH, SAEs and SAH. Further sub-analyses are needed to identify patients with a more favorable risk–benefit profile.

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