Abstract Details

Title Endovascular Therapy vs Medical Therapy for Acute Ischemic Stroke with Distal Medium Vessel Occlusion: An Updated Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-018

Objective We conducted a meta-analysis and systematic review to compare the efficacy and safety of endovascular therapy (EVT) versus best medical therapy (BMT) in patients with acute ischemic stroke due to distal medium vessel occlusions (DMVOs).

Background Endovascular thrombectomy (EVT) is well-established for large vessel occlusions in acute ischemic stroke. However, its efficacy for distal medium vessel occlusions (DMVOs) remains uncertain. This meta-analysis aims to evaluate the current evidence on EVT versus best medical therapy for DMVO-related acute ischemic strokes.

Design/Methods

We conducted a comprehensive literature search from inception to September 2024 across PubMed, Cochrane Library, Google Scholar, and Embase, identifying studies comparing EVT with BMT for DMVO-AIS. Our primary outcome was functional independence at 90 days (modified Rankin Scale 0-2), with mortality as a secondary outcome. Data extraction and quality assessment were performed by two independent reviewers. Statistical analysis utilized RevMan v5.4, employing a random-effects model to calculate odds ratios and confidence intervals, while assessing heterogeneity using the I² statistic.

Results Our meta-analysis included 24 studies with 7,569 DMVO-AIS patients (4,121 EVT, 3,448 BMT). For 90-day functional independence, EVT showed a trend toward better outcomes (OR 1.02, 95% CI 0.81-1.30) after trim-and-fill correction, but this was not statistically significant (I² = 76%). For 90-day mortality, EVT indicated reduced odds (OR 1.25, 95% CI 0.93-1.68), also not statistically significant (I² = 40%). These findings suggest a potential benefit of EVT over BMT for DMVO-AIS, but the lack of significance and heterogeneity highlight the need for further research to confirm these results.

Conclusions EEVT shows promising trends towards improved functional independence and reduced mortality at 90 days compared to best medical therapy for DMVO-AIS, although not reaching statistical significance. These findings highlight the need for large-scale randomized controlled trials to definitively evaluate the efficacy and safety of EVT in DMVO-AIS

Authors/Disclosures
Nishitha Bujala, MBBS (Kamineni Institute of Medical Sciences) PRESENTER	Dr. Bujala has nothing to disclose.
Sangharsha Thapa, MD	Dr. Thapa has nothing to disclose.
Sangam Shah (Tribhuvan University, Institute of Medicine)	Dr. Shah has nothing to disclose.
Ji Y. Chong, MD (Westchester Medical Center)	Dr. Chong has nothing to disclose.
Chirag Gandhi (Westchester Medical Center)	Chirag Gandhi has nothing to disclose.
Fawaz Al-Mufti, MD (Westchester Medical Center at New York Medical College)	Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Revalesio .
Gurmeen Kaur, MBBS (Westchester Medical Center)	Dr. Kaur has nothing to disclose.
Justin G. Santarelli, MD	Dr. Santarelli has nothing to disclose.

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