Endovascular treatment versus standard medical management in primary M3 or M4 occlusion stroke in clinical practice: the oriental-MeVO registry

BACKGROUND: Clinical evidence of the potential treatment benefit of endovascular treatment (EVT) for M3 occlusion of the middle cerebral artery (MCA) is sparse. This study aims to compare EVT versus standard medical management (SMM) for acute M3 and M4 occlusion stroke. METHODS: This multicenter, retrospective study collected data on patients with acute ischemic stroke from an M3 or M4 occlusion from 25 comprehensive stroke centers between 09/2019 and 09/2024. The primary endpoint was the proportion of excellent outcome (modified Rankin Scale mRS 0-1) at 90 days. Safety measures included symptomatic intracranial hemorrhage (sICH) within 24 h and mortality at 90 days. RESULTS: A total of 342 patients with M3 or M4 occlusions were enrolled in the final analysis (EVT, 170; SMM, 172). In the primary analysis, there was no significant difference in EVT cohort versus SMM cohort regarding the rates of excellent outcome (mRS 0-1, 36.5% versus 37.2%, adjusted risk ratio aRR, 0.88 95% CI, 0.64-1.22; P = 0.45), overall distribution of mRS score (adjusted common odds ratio aOR, 0.94 95% CI, 0.69-1.26; P = 0.66), and functional independence (mRS 0-2, 53% versus 55.2%, aRR, 0.76 95% CI, 0.55-1.05; P = 0.10). There was no significant difference in safety measures between EVT and SMM cohorts in terms of sICH (aRR, 1.04 95% CI, 0.63-1.72; P = 0.85) and 90-day mortality (aRR, 0.76 95% CI, 0.43-1.34; P = 0.35). Successful revascularization was correlated with excellent outcome at 90 days (aRR, 2.79 95% CI, 1.42-5.51; P = 0.003) in the EVT cohort. CONCLUSIONS: EVT appears to be a safe and technically feasible treatment option for primary isolated M3 and M4 occlusions with clinical outcomes similar to SMM. TRIAL REGISTRATION: URL: www.chictr.org.cn; Unique identifier: ChiCTR2500096954, February 10, 2025.