2026-10-12T19:27:22Z https://api.figshare.com/v2/oai

oai:figshare.com:article/33993871 2026-09-25T07:51:34Z category_7 portal_147 item_type_3 month_year_09_2026

Supplemental Material for: Is Endovascular Thrombectomy Effective for Distal Medium Vessel Occlusion Stroke? A Meta-Analysis of Randomized Controlled Trials and Observational Studies figshare admin karger (2628495) Jian Wu (41301) Fuli Yan (11305161) Jia-Ying Li (316807) Jun‐Long Huang (20751131) Ming-Fei Yang (11855132) Zhan-Ying Ju (25108249) Medicine Medicine <p dir="ltr">Introduction: Endovascular thrombectomy (EVT) is currently widely recommended for patients with large vessel occlusion stroke. However, evidence regarding its safety and efficacy in patients with distal medium vessel occlusion (DMVO) remains insufficient. Additionally, the effects of EVT in DMVO patients with varying degrees of severity are not well defined.</p><p dir="ltr">Methods: A systematic search was conducted across medical and biological databases since their inception to identify randomized controlled trials (RCTs) and observational studies comparing EVT with best medical treatment (BMT) in patients with DMVO ischemic stroke. Patients were stratified into three groups based on National Institutes of Health Stroke Scale (NIHSS) scores: mild stroke group (<6), moderate-to-severe stroke group (≥6), and NIHSS-unreported group (no clear score available). Additionally, patients were divided into three groups according to the occlusion site of the stroke: middle cerebral artery (MCA) group, posterior cerebral artery (PCA) group, and anterior cerebral artery (ACA) group. The primary efficacy outcome was excellent outcome, defined as a 90-day modified Rankin Scale (mRS) score of 0–1. Secondary outcomes included 90-day functional independence (mRS 0–2), 90-day mortality, and symptomatic intracranial hemorrhage (sICH).</p><p dir="ltr">Results: 3 RCTs (n=1233) and 39 observational studies (n=11148) were included. In RCTs, there was no statistically significant difference between EVT combined with BMT and BMT alone in terms of mRS 0-1 (RR 0.95, 95% CI 0.82–1.10, p = 0.46) and mRS 0-2 (RR 0.92, 95% CI 0.80–1.06, p = 0.27), and the mortality rates were also similar between the two groups (OR 1.23, 95% CI 0.76–1.99, p = 0.21). However, EVT significantly increased the risk of sICH (OR 2.38, 95% CI 1.35–4.20, p = 0.003). In the observational study cohort, there were no significant differences between EVT and BMT in terms of mRS 0-1 (RR 1.03, 95% CI 0.93–1.14, p = 0.56), mRS 0-2 (RR 1.01, 95% CI 0.94–1.08, p = 0.80), and mortality (OR 1.10, 95% CI 0.89–1.36, p = 0.37), while the risk of sICH remained significantly higher in the EVT group (OR 1.69, 95% CI 1.14–2.50, p = 0.008). Subgroup analyses from observational studies suggested potential baseline NIHSS stratification differences in treatment effects. In the primary NIHSS >= 6 subgroup analysis, EVT did not show a statistically significant difference compared with BMT for mRS 0-1 (RR 1.10, 95% CI 0.93-1.30, p = 0.28) or mRS 0-2 (RR 1.06, 95% CI 0.94-1.19, p = 0.34). In a sensitivity analysis excluding studies contributing to heterogeneity, a potential signal for benefit emerged (mRS 0-1: RR 1.18, 95% CI 1.01-1.37, p = 0.04), though this should be interpreted cautiously as a secondary exploratory finding. Conversely, in patients with mild symptoms and NIHSS < 6, BMT alone may be non-inferior (RR 0.91, 95% CI 0.82-1.00, p = 0.05). These subgroup observations are hypothesis-generating and require confirmation in prospective trials.</p><p dir="ltr">Conclusion: Based on RCT evidence, EVT does not significantly improve functional outcomes in the overall DMVO population but increases the risk of sICH. Exploratory subgroup analyses from observational studies suggest a potential gradient effect whereby EVT may be associated with better functional outcomes in patients with more severe stroke (NIHSS >= 6) and more proximal occlusions (MCA-M2, PCA-P1), though these findings are hypothesis-generating and require validation in adequately powered randomized controlled trials. For patients with NIHSS < 6 or more distal occlusions, BMT alone may provide equivalent or better outcomes.</p> 2026-09-25T07:51:34Z Dataset Dataset 10.6084/m9.figshare.33993871.v1 https://figshare.com/articles/dataset/Supplemental_Material_for_Is_Endovascular_Thrombectomy_Effective_for_Distal_Medium_Vessel_Occlusion_Stroke_A_Meta-Analysis_of_Randomized_Controlled_Trials_and_Observational_Studies/33993871 CC BY 4.0