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February 6, 2025
A groundbreaking study presented at the American Stroke Association’s International Stroke Conference 2025 has revealed that removing a clot blocking medium- or small-sized arteries in the brain through mechanical retrieval is a safe option, but it does not reduce disability more than standard medical treatments, including clot-busting medications.
The research, led by Dr. Marios Psychogios, a renowned expert in diagnostic and interventional neuroradiology at the University Hospital Basel, Switzerland, looked at a condition known as medium distal vessel occlusion (MDVO). This occurs when a clot blocks medium- or small-sized arteries above the base of the brain, a form of ischemic stroke that affects 20–40% of stroke patients. Though traditionally thought to have a favorable prognosis, more recent studies suggest that only half of those affected regain functional independence.
Endovascular therapy, a minimally invasive procedure that uses a stent-retriever or aspiration catheter to remove clots and restore blood flow, has been a common treatment for large artery blockages. However, the benefits of this therapy for medium distal vessel occlusions have been uncertain.
The study, called the DISTAL trial, included 543 patients who experienced disabling stroke symptoms and were randomly assigned to receive either standard medical care (including intravenous clot-busting medication) or the same medical care plus endovascular treatment. The goal was to see whether the addition of clot removal through mechanical means would further reduce disability when measured 90 days after the stroke.
The results were surprising. There was no significant difference in disability between the two groups, with similar outcomes observed in both the endovascular therapy and medical care-only groups. Additionally, both groups had comparable rates of death, with 15.5% of the endovascular group and 14% of the standard care group passing away. Rates of severe brain bleeds were also higher in the endovascular group (5.9%) compared to the standard medical care group (2.6%).
“While endovascular therapy is a safe procedure, it did not offer substantial additional benefits in reducing disability compared to standard treatment,” said Dr. Urs Fischer, co-principal investigator of the study and director of neurology at the University Hospital Bern. “It may be worth reconsidering it as the standard treatment for medium distal vessel occlusions, but it should still be considered for select patients on a case-by-case basis.”
Researchers were particularly surprised by the overall severity of outcomes, which were worse than expected based on previous retrospective studies. They also highlighted that the majority of study participants were white, which raises concerns about whether the results can be generalized to other populations.
The researchers stressed that these findings serve as a wake-up call to continue investigating treatment options for medium distal vessel occlusion patients. “Outcomes appear to be more severe than expected, and evidence-based effective treatments are still lacking,” said Dr. Psychogios.
Disclaimer:
This article presents preliminary results from a study presented at the 2025 American Stroke Association’s International Stroke Conference. As research is ongoing, conclusions may change as further analysis is completed. Always consult with a healthcare provider for advice on treatment options for specific medical conditions.
