Endovascular thrombectomy (EVT) is a well-established and effective treatment for acute ischemic stroke due to large-vessel occlusion, with proven impact on patient mortality and functional outcomes. However, whether this benefit holds true for stroke due to medium-vessel occlusion is unclear.

The ESCAPE-MeVO is a multicenter, prospective, randomized, controlled trial that enrolled 528 patients recruited from hospital emergency departments at the time of presentation with acute ischemic stroke caused by a medium vessel occlusion. Patients were randomized in a 1:1 fashion within 12 hours after stroke onset to usual care or usuale care plus EVT. At 90 days follow-up, the primary functional outcome (reported as the percentage of patients with a modified Rankin score of 0 or 1) was similar between the two groups (adjusted rate ratio 0.95; 95%CI 0.79-1.15). Mortality at 90-days and symptomatic intracranial hemorrhage were found higher in the EVT group as compared to the usual care group (13.3% Vs 8.4% and 5.4% Vs 2.2% respectively). Overall, a substantial proportion (approximately 40%) of the patients had substantial disability at 90 days and EVT for acute ischemic stroke due to medium vessel occlusion within 12 hours did not lead to better outcomes than usual care.