Medium and distal vessel occlusion stroke: Redefining the role of thrombectomy through technology, timing, and patient selection
TL;DR
In the large SITS International Stroke Register (SITS-ISTR) analysis, the addition of EVT to intravenous thrombolysis (IVT) was associated with lower rates of functional independence and higher mortality compared with IVT alone after propensity-score matching.
Abstract
, Growing evidence on the use of endovascular thrombectomy (EVT) for medium and distal vessel occlusions (MDVOs) has sparked important debate about how mechanical reperfusion should be applied beyond the setting of large vessel occlusion (LVO) stroke. Recent observational and randomized data have raised concerns regarding the efficacy and safety of EVT in MDVO. In the large SITS International Stroke Register (SITS-ISTR) analysis by Keselman et al ., the addition of EVT to intravenous thrombolysis (IVT) was associated with lower rates of functional independence and higher mortality compared with IVT alone after propensity-score matching. [6] Together with randomized trials reporting neutral or negative results, these findings have intensified the debate regarding whether EVT is intrinsically limited in MDVO stroke or whether current outcomes reflect limitations in patient selection, technology, and procedural implementation. [2,3,9] However, interpretation of these findings requires caution. e SITS-ISTR analysis is an