Endovascular thrombectomy in addition to intravenous thrombolysis versus intravenous thrombolysis alone in medium distal vessel occlusions (MDVO)– results from the SITS international stroke register (SITS ISTR)

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Key Points

The study aims to determine if adding endovascular thrombectomy (EVT) to intravenous thrombolysis (IVT) benefits or harms patients with MDVO strokes.
Retrospective observational study using SITS-ISTR data from 2016-2023.
Included patients treated with IVT or IVT+EVT for occlusion of the ACA, PCA, or distal MCA.
Propensity score matching was applied due to baseline imbalances.
After matching, IVT+EVT was associated with worse outcomes: mRS 0-1 (35.8% vs 47.0%, p=0.016), mRS 0-2 (52.4% vs 63.4%, p=0.017), and death (21.4% vs 11.8%, p=0.005).
Symptomatic intracerebral hemorrhage rates were higher in the IVT+EVT group (6.5% vs 2.4%, p=0.043).

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Retrospective observational study finds worse outcomes with endovascular thrombectomy added to thrombolysis in MDVO cases, suggesting caution.

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Keselman et al. (2026) studied this question.

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