Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels

作者：Marios‐Nikos Psychogios, Alex Brehm, Marc Ribó, Federica Rizzo, Daniel Strbian, Silja Räty, Juan F. Arenillas, Mario Martínez‐Galdámez, Steven Hajdu, Patrik Michel, Jan Gralla, Eike I. Piechowiak, Daniel Kaiser, Volker Puetz, F. van den Bergh, Sylvie De Raedt, Flavio Bellante, Anne Dusart, Victoria Hellstern, Ali Khanafer, G. Parrilla, A. Morales, Jan S. Kirschke, Silke Wunderlich, Jens Fiehler, Götz Thomalla, Robin Lemmens, Jo P. Peluso, Manuel Bolognese, Alexander von Hessling, Adriaan van Es, Nyika D. Kruyt, Jonathan M. Coutinho, Carlos Castaño, Jens Minnerup, Wim H. van Zwam, Elisabeth Dhondt, Christian H. Nolte, Paolo Machi, Christian Loehr, Heinrich P. Mattle, Jan-Hendrik Buhk, Johannes Kaesmacher, Tomas Dobrocky, Panagiotis Papanagiotou, Angelika Alonso, Markus Holtmannspoetter, Andrea Zini, Leonardo Renieri, Fee Keil, Ido R. van den Wijngaard, Georg Kägi, Mikel Terceño, Martin Wiesmann, Sergio Amaro, Nikki Rommers, Luzia Balmer, Isabel Fragata, Mira Katan, Ronen R. Leker, Jeffrey L. Saver, Julie Staals, Urs Fischer · 发表于：New England Journal of Medicine · 年份：2025 · DOI：10.1056/nejmoa2408954 · 被引用次数：258 · 研究领域：Acute Ischemic Stroke Management、Moyamoya disease diagnosis and treatment、Cerebrovascular and Carotid Artery Diseases

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 s...