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Endovascular Treatment for Acute Ischemic Stroke Due to Medium Vessel Occlusion: A Systematic Review with Meta-Analysis

Published online by Cambridge University Press:  13 November 2025

Farsana Mustafa Open the ORCID record for Farsana Mustafa [Opens in a new window] ,
Baikuntha Panigrahi Open the ORCID record for Baikuntha Panigrahi [Opens in a new window] ,
Partha Haldar  and
Rohit Bhatia
Farsana Mustafa
Affiliation:
Department of Neurology, All India Institute of Medical Sciences , New Delhi, India
Baikuntha Panigrahi
Affiliation:
Department of Neurology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
Partha Haldar
Affiliation:
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
Rohit Bhatia*
Affiliation:
Department of Neurology, All India Institute of Medical Sciences , New Delhi, India
*
Corresponding author: Rohit Bhatia; Email: rohitbhatia@yahoo.com
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Abstract

Background/Objective:

The benefit of endovascular treatment (EVT) in acute ischemic strokes (AIS) due to medium vessel occlusion (MeVO) remains unclear, as recent randomized controlled trials (RCTs) have shown neutral results. This meta-analysis examines the pooled efficacy and safety of EVT in MeVO.

Methods:

A systematic review and meta-analysis of two RCTs (DISTAL and ESCAPE-MeVO) involving 1073 participants was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The primary outcome was the risk ratios (RR) of excellent functional outcome, defined as modified Rankin score (mRS) 0–1 at 90 days. Secondary outcomes included mRS 0–2 and symptomatic intracranial hemorrhage (sICH).

Results:

The RR implied no significant difference between the two treatment arms; for the primary efficacy outcome, RR (mRS 0–1) was 0.95 (95% CI: 0.81–1.10; I2 = 0%), and for the secondary efficacy outcome, RR (mRS 0–2) was 0.98 (95% CI: 0.88–0.09; I2 = 10%). The EVT + best medical treatment (BMT) arm demonstrated a higher risk of sICH (RR: 2.39, 95% CI: 1.26–4.53; I2 = 0%) and serious adverse events (SAE) (RR: 1.32, 95% CI: 1.11–1.56; I2 = 0%), while mortality at 90 days (RR: 1.29, 95% CI: 0.94–1.76; I2 = 16%) showed no significant difference.

Conclusions:

Our study showed that, in patients with AIS due to MeVO, EVT did not lead to better outcomes at 90 days when compared to BMT and was associated with a higher risk of sICH and SAEs compared to usual care, and this result was confirmed in a trial sequential analysis.

PROSPERO registration:

The study protocol was registered with the International Prospective Register of Systematic Reviews under the registration identification number CRD420250653970.

Résumé

RÉSUMÉ

Reprise de la conduite automobile après une craniotomie : résultats d’une revue a systématique et approche fondée sur des données probantes.

Contexte :

Les patients qui subissent une craniotomie connaissent un risque accru d’épilepsie au cours des mois suivant l’opération. La question du délai le plus approprié avant la reprise de la conduite automobile après une craniotomie chez les personnes qui, par ailleurs, ne souffrent pas de déficit neurologique ou qui n’ont pas d’antécédents d’épilepsie ne fait pas encore l’objet de consensus.

Méthodes :

L’équipe de recherche a tout d’abord procédé à un examen systématique de la documentation sur les recommandations relatives à la conduite automobile après une craniotomie. Elle a ensuite fait une revue exploratoire des connaissances sur le risque d’épilepsie consécutif à une craniotomie, employé les calculs de risque et accepté les seuils de risque tirés de la documentation sur l’épilepsie afin d’élaborer une approche fondée sur des données probantes en vue de formuler des recommandations sur la conduite automobile après une craniotomie.

Résultats :

Trois ensembles de directives nationales (Royaume-Uni, Nouvelle-Zélande, Australie) se sont dégagés de la revue systématique des recommandations sur la conduite automobile. L’équipe a ensuite transposé les calculs de risque et accepté les seuils de risque tirés de la documentation sur l’épilepsie (rapport de risques d’accident : < 2; risque de survenue d’une crise d’épilepsie au cours de l’année suivante : < 20 %), appliqués aux patients ayant subi une craniotomie. Les auteurs ont par la suite calculé les rapports de risques d’accident pour diverses affections sous-jacentes, à différents moments après l’opération, à l’aide de données provenant d’une grande méta-analyse sur le risque d’épilepsie après une craniotomie, puis comparé les résultats avec les seuils de risque acceptés, puisés dans la documentation sur l’épilepsie. Aussi l’équipe a-t-elle déterminé, d’une part, que les patients ayant subi une craniotomie pour des affections associées à des risques élevés (p. ex. un gliome de degré élevé de malignité) pouvaient conduire de nouveau après avoir passé au moins 1 mois sans connaître de crise d’épilepsie et, d’autre part, que les patients ayant subi une craniotomie pour des affections associées à des risques faibles (p. ex. une affection sous-tentorielle) pouvaient reprendre la conduite automobile sans égard au risque d’épilepsie.

Conclusion :

Les résultats de la revue systématique de la documentation et l’approche fondée sur des données probantes quant aux calculs des seuils de risque provenant de la documentation sur l’épilepsie fournissent aux médecins un cadre préliminaire de recommandations sur la reprise de la conduite automobile après une craniotomie.

Keywords

DISTALendovascular treatmentESCAPE-MeVOmedium vessel occlusionbest medical treatment

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 10
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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