Endovascular Treatment in Acute Ischemic Stroke Due to Occlusion of Medium or Distal Vessels
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Endovascular treatment (EVT) is the standard of care for acute ischemic stroke (AIS) due to large vessel occlusions, but its efficacy and safety in medium or distal vessel occlusions (MDVOs) remain uncertain. This systematic review and meta-analysis evaluated EVT plus best medical treatment (BMT) vs BMT alone in patients with MDVO-AIS. METHODS: MEDLINE, Scopus, and ClinicalTrials.gov were searched through February 2025 for randomized-controlled clinical trial (RCT) data and observational evidence comparing EVT plus BMT vs BMT alone in adults with MDVO-AIS. The primary efficacy outcome was 3-month excellent functional outcome (modified Rankin Scale [mRS]-score 0-1), while good functional outcome (mRS score 0-2), reduced disability (mRS shift analysis), and pooled rates of successful recanalization were assessed as secondary outcomes. The primary safety outcome was symptomatic intracranial hemorrhage (sICH), while any ICH, 3-month all-cause mortality, and procedure-related complications were also evaluated. RESULTS: = 76%). No significant subgroup differences emerged when stratified for study design or NIH Stroke Scale strata. DISCUSSION: In this comprehensive synthesis of available evidence, EVT did not improve functional outcomes compared with BMT in MDVO-AIS, while it increased the risk of hemorrhagic complications and mortality. These findings argue against the routine use of EVT for MDVO-AIS. A key limitation is the predominance of observational data, underscoring the need for further RCTs to refine patient selection. TRIAL REGISTRATION INFORMATION: The prespecified protocol of the present systematic review and meta-analysis has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (registration ID: CRD42025651283).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.008 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".