Reperfusion Strategies For Medium And Distal Vessel Occlusion: A Systematic Review And Network Meta-Analysis.
Abstract Body (Do not enter title and authors here): Evidence on the most effective treatment for stroke due to distal and medium vessel occlusions (DMVOs) remains unclear, as existing meta-analyses compare heterogeneous groups. We conducted a network meta-analysis to directly and indirectly compare different treatments for DMVOs
We performed a comprehensive search of databases through April 2025 to identify studies comparing endovascular treatment (EVT) with other therapies in DMVOs. We included 31 studies with EVT, intravenous thrombolysis (IVT), medical management (MM), and conservative management (CM) groups, including 7500 patients. Outcomes assessed included 90-day favorable modified Rankin Scale (mRS0–2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.
Compared to CM, EVT was associated with a higher rate of mRS 0–2 (RR:2.79, CI:95% 1.28–6.11, p = 0.01), while MM and IVT showed no significant differences. For mRS 3–6, CM (RR:3.05, CI:95% 1.43–6.55, p = 0.004) and thrombolysisIVT (RR:1.34, CI:95% 1.01–1.77, p = 0.04) carried greater risk than EVT. MM (RR: 0.59, CI:95% 0.35–1.00, p = 0.0498), IVT (RR:0.57, CI:95% 0.29–1.10, p = 0.10), and CM (RR:0.14, CI:95% 0.005–4.16, p = 0.26) showed non-significant lower sICH risk compared to EVT. No significant differences were found in 90-day mortality.
EVT consistently showed a favorable profile for mRS 0–2 at 90 days, with a non-significant increase in sICH and in 90-day mortality. These findings support EVT to improve functional recovery in DMVOs.
Aragon Cortes, Amiel
( Universidad Autonoma de Baja California
, Tijuana
, Mexico
)
Beltran De La Fuente, Andrea Cristina
( Universidad Mexico Americana Del No
, Reynosa, Tamaulipas
, Mexico
)
López Mena, Diego
( Instituto Nacional de Neurologia y Neurocirugia
, Ciudad de Mexico
, Mexico
)
Orozco Santiago, Ricardo Alberto
( Universidad Autonoma de Baja California
, Tijuana
, Mexico
)
Calderon-fernandez, Adolfo
( Universidad Autonoma de Baja California
, Tijuana
, Mexico
)
Torrico Beltran, Valentina
( Universidad Catolica Boliviana
, Santa Cruz de la Sierra
, Bolivia, Plurinational State of
)
Cueva, Luis E.
( Universidad Nacional de Piura
, Piura
, Peru
)
Natera, Dilmareth
( University of Minnesota
, Shakopee
, Minnesota
, United States
)
Gasca, Jose
( Universidad Santiago de Cali
, Cali
, Colombia
)
Zuñiga Montaño, Karoly Pamela
( Universidad Catolica Boliviana
, Santa Cruz de la Sierra
, Bolivia, Plurinational State of
)
Polania Perez, Olga Nataly
( Universidad de Santander
, Cucuta
, Colombia
)
Author Disclosures:
Amiel Aragon Cortes:DO NOT have relevant financial relationships
| Andrea Cristina Beltran De la Fuente:DO NOT have relevant financial relationships
| Diego López Mena:No Answer
| Ricardo Alberto Orozco Santiago:No Answer
| Adolfo Calderon-Fernandez:DO NOT have relevant financial relationships
| Valentina Torrico Beltran:No Answer
| Luis E. Cueva:DO NOT have relevant financial relationships
| Dilmareth Natera:DO NOT have relevant financial relationships
| Jose Gasca:DO NOT have relevant financial relationships
| Karoly Pamela Zuñiga Montaño:No Answer
| Olga Nataly Polania Perez:No Answer
Aragon Cortes Amiel, Calderon-fernandez Adolfo, Ramos Pillado Francisco, Natera Dilmareth, García Díaz Susana Guadalupe, Cueva Luis E., López Mena Diego
