Endovascular thrombectomy is indicated for acute ischemic stroke due to a large vessel occlusion in the anterior circulation within 24 hours of the time last known to be well.The ORIENTAL-MeVO randomized trial from China found that mechanical thrombectomy also improved outcomes for acute middle-vessel occlusion stroke.The findings might help expand patient selection for this treatment, although further trials in a Western population might be needed to confirm the benefit.
For patients with moderate-to-severe deficits from an acute middle-vessel occlusion stroke, endovascular treatment within 24 hours of onset improved functional independence, the Chinese ORIENTAL-MeVO trial found.
Survival without more than mild disability at 90 days (modified Rankin Scale score of 0-2 on the 6-point scale) was 24% more likely with randomization to thrombectomy compared with medical treatment alone (58.6% vs 46.6%, adjusted RR 1.24, 95% CI 1.07-1.44, P=0.004), Wei Hu, MD, of the First Affiliated Hospital of the University of Science and Technology of China in Hefei, and colleagues reported in the New England Journal of Medicine.
The impact on functional outcomes was clinically meaningful, the group wrote, with a number needed to treat of 8.2 to observe a functional-independence outcome -- "a magnitude similar to that reported for established reperfusion therapies in acute ischemic stroke and consistent with meaningful improvement in patient-centered functional outcomes."
