ESCAPE-MeVO
Trial question
What is the role of endovascular treatment in patients with AIS due to medium vessel occlusion?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
46.0% female
54.0% male
N = 529
529 patients (245 female, 284 male).
Inclusion criteria: patients with AIS due to medium vessel occlusion within 12 hours after last known well.
Key exclusion criteria: pregnancy; major comorbid illness; nursing home resident; ICH; lack of core penumbra mismatch; diffusion restriction in the majority of the brain parenchyma supplied by the occluded vessel.
Interventions
N=255 endovascular therapy (minimally invasive endovascular surgery for mechanical removal of occluding intracranial thrombus plus standard-of-care).
N=274 usual care (current standard-of-care treatment according to modern acute stroke care guidelines).
Primary outcome
Modified Rankin Scale score 0-1 at day 90
41.6%
43.1%
43.1 %
32.3 %
21.6 %
10.8 %
0.0 %
Endovascular
therapy
Usual
care
No significant
difference ↔
No significant difference in mRS score 0-1 at day 90 (41.6% vs. 43.1%; RR 0.95, 95% CI 0.79 to 1.15).
Secondary outcomes
No significant difference in mRS score 0-2 at day 90 (54.1% vs. 58.8%; RR 0.92, 95% CI 0.8 to 1.05).
Significant increase in death at day 90 (13.3% vs. 8.4%; HR 1.82, 95% CI 1.06 to 3.12).
Significant decrease in Barthel Index ≥ 95 at day 90 (53.5% vs. 64.7%; RR 0.81, 95% CI 0.71 to 0.93).
Safety outcomes
No significant difference in symptomatic ICH.
Conclusion
In patients with AIS due to medium vessel occlusion within 12 hours after last known well, endovascular therapy was not superior to usual care with respect to mRS score 0-1 at day 90.
Reference
Mayank Goyal, Johanna M Ospel, Aravind Ganesh et al. Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion. N Engl J Med. 2025 Apr 10;392(14):1385-1395.
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