International Stroke Conference 2025  /  Late-Breaking Science Oral Abstracts I  /  Volume of brain saved in patients with a medium distal vessel occlusion stroke treated with endovascular therapy plus best medical treatment versus best medical treatment alone: A sub-analysis of the DISTAL Trial
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American Heart Association

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Final ID: LB5

Volume of brain saved in patients with a medium distal vessel occlusion stroke treated with endovascular therapy plus best medical treatment versus best medical treatment alone: A sub-analysis of the DISTAL Trial

Abstract Body: BACKGROUND
We aimed to estimate the effect of endovascular therapy (EVT) in addition to best medical treatment (BMT) compared to BMT alone on the volume of brain tissue that was saved after an acute ischemic stroke (AIS) due to a medium distal vessel occlusion (MDVO).
HYPOTHESIS
We assessed the hypothesis that EVT in addition to BMT compared to BMT alone leads to a bigger volume of saved brain tissue in AIS patient with a MDVO.
METHODS
We based our analysis on the data collected from the DISTAL Trial (ClinicalTrials.gov Identifier: NCT05029414), an investigator-initiated, open-label, multicenter, randomized, two-arm, assessor-blinded trial at 61 sites in 11 countries with the goal to randomly assign 543 eligible participants in a 1:1 ratio to EVT plus BMT or BMT alone. Eligible patients had an isolated occlusion of either the co- or non-dominant M2 segment, the M3 or M4 segment of the middle cerebral artery, the A1, A2 or A3 segment of the anterior cerebral artery or the P1, P2 or P3 segment of the posterior cerebral artery that was confirmed on non-invasive vessel imaging and that could be treated within 24 hours of symptom onset.
In this sub-analysis we used the available imaging data of those patients. We included only patients with baseline perfusion imaging (CT or MRI) and available follow-up imaging (CT or MRI within the first 24 hours). We compared the affected volume of brain tissue in ml at baseline, assessed using the the tissue at risk on perfusion, and follow-up imaging, assessed by the demarcation on CT or FLAIR MRI sequence. Specifically, we measured the volume of the penumbra defined by Tmax thresholds at baseline and segmented the demarcation of the infarct volume at follow-up through manual or algorithmic methods. The segmentations were made from a blinded resident neuroradiologist and were corrected from a second experienced neuroradiologist.
The primary endpoint was the difference of tissue at risk and final infarct. ΔVol (ml) = Volume of the tissue at risk (Baseline perfusion) - Volume of the demarcation (24h follow-up). As a secondary analysis we will test the hypothesis that the ΔV in patients with NIHSS > 5 in the EVT + BMT group is bigger from that from the BMT alone group.
RESULTS
A total of 543 patients (44% female, mean age 74.8 years) were assigned to either EVT plus BMT (N=271) or the control group (N=272). The results will be available at ISC 2025.
CONCLUSION
Results will be available at ISC 2025.
  • Anastasiou, Aikaterini  ( University Hospital Basel , Basel , Switzerland )
  • Arenillas, Juan  ( University Hospital Valladolid , Barcelona , Spain )
  • Martínez-galdámez, Mario  ( University Hospital Valladolid , Valladolid , Spain )
  • Hajdu, Steven  ( Centre hospitalier universitaire vaudois , Lausanne , Switzerland )
  • Michel, Patrik  ( Centre hospitalier universitaire vaudois , Lausanne , Switzerland )
  • Gralla, Jan  ( Inselspital, University Hospital Bern , Bern , Switzerland )
  • Piechowiak, Eike  ( Inselspital, University Hospital Bern , Bern , Switzerland )
  • Kaiser, Daniel  ( Institute of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany )
  • Puetz, Volker  ( Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany )
  • Van Den Bergh, Frans R.a.  ( University Hospital Brussels , Brussels , Belgium )
  • De Raedt, Sylvie  ( University Hospital Brussels , Brussels , Belgium )
  • Corbaz, Helene  ( University Hospital Basel , Basel , Switzerland )
  • Bellante, Flavio  ( , Hôpital Civil Marie Curie, CHU Charleroi , Charleroi , Belgium )
  • Dusart, Anne  ( , Hôpital Civil Marie Curie, CHU Charleroi , Charleroi , Belgium )
  • Hellstern, Victoria  ( University Hospital Stuttgart , Stuttgart , Germany )
  • Khanafer, Ali  ( University Hospital Stuttgart , Stuttgart , Germany )
  • Parrilla, Guillermo  ( University Hospital Virgen de la Arrixaca , Murcia , Spain )
  • Morales, Ana  ( University Hospital Virgen de la Arrixaca , Murcia , Spain )
  • Kirschke, Jan  ( TUM University Hospital , Munich , Germany )
  • Wunderlich, Silke  ( TUM University Hospital , Munich , Germany )
  • Fiehler, Jens  ( University Medical Center Hamburg-Eppendorf , Hamburg , Germany )
  • Thomalla, Gotz  ( University Medical Center Hamburg-Eppendorf , Hamburg , Germany )
  • Brehm, Alex  ( University Hospital Basel , Basel , Switzerland )
  • Lemmens, Robin  ( University Hospital Leuven , Leuven , Belgium )
  • Peluso, Jo  ( University Hospital Leuven , Leuven , Belgium )
  • Bolognese, Manuel  ( Luzerner Kantonsspital , Lucerne , Switzerland )
  • Von Hessling, Alexander  ( Luzerner Kantonsspital , Lucerne , Switzerland )
  • Van Es, Adriaan  ( Leiden University Medical Centre , Leiden , Netherlands )
  • Kruyt, Nyika  ( Leiden University Medical Center , Leiden , Netherlands )
  • Coutinho, Jonathan  ( Amsterdam University Medical Centers , Amsterdam , Netherlands )
  • Castano, Carlos  ( University Hospital Germans Trias i Pujol , Badalona , Spain )
  • Minnerup, Jens  ( University of Münster , Münster , Germany )
  • Van Zwam, Wim  ( , Maastricht University Medical Centre , Maastricht , Netherlands )
  • Müller, Lioba  ( University Hospital Basel , Basel , Switzerland )
  • Dhondt, Elisabeth  ( Ghent University Hospital , Ghent , Belgium )
  • Nolte, Christian  ( Charité - Universitätsmedizin , Berlin , Germany )
  • Machi, Paolo  ( Geneva University Hospitals , Geneva , Switzerland )
  • Loehr, Christian  ( Klinikum Vest , Recklinghausen , Germany )
  • Mattle, Heinrich  ( UNIVERSITY OF BERN , Bern , Switzerland )
  • Buhk, Jan-hendrik  ( Diagnostic and Interventional Neuroradiology Asklepios hospitals St. Georg and Wandsbeck, Hamburg, Germany , Hamburg , Germany )
  • Kaesmacher, Johannes  ( Inselspital, University Hospital Bern , Bern , Switzerland )
  • Dobrocky, Tomas  ( Inselspital, University Hospital Be , Freiburgstrasse , Switzerland )
  • Papanagiotou, Panagiotis  ( Klinikum Bremen-Mitte , Bremen , Germany )
  • Alonso, Angelika  ( Universitätsklinikum Mannheim GmbH , Mannheim , Germany )
  • Christodoulou, Evangelia  ( University Hospital Basel , Basel , Switzerland )
  • Holtmannspoetter, Markus  ( Hospital Nuremberg-South Campus , Nuremberg , Germany )
  • Zini, Andrea  ( Maggiore Hospital , Bologna , Italy )
  • Renieri, Leonardo  ( Careggi University Hospital , Florence , Italy )
  • Keil, Fee  ( Universitätsklinikum Frankfurt , Frankfurt , Switzerland )
  • Van Den Wijngaard, Ido  ( Haaglanden Medical Center , Den Haag , Netherlands )
  • Kaegi, Georg  ( Kantonsspital St. Gallen , St. Gallen , Switzerland )
  • Fragata, Isabel  ( Central University Hospital Lisboa , Lisboa , Portugal )
  • Katan, Mira  ( University Hospital of Basel , Basel , Switzerland )
  • Leker, Ronen  ( Hadassah-Hebrew University Medical Center , Jerusalem , Israel )
  • Saver, Jeffrey  ( David Geffen School of Medicine of UCLA , Los Angeles , California , United States )
  • Ribo, Marc  ( Hospital Vall d’Hebron , Barcelona , Spain )
  • Staals, Julie  ( Department of Neurology, Maastricht University Medical Centre, Maastricht, the Netherlands , Maastricht , Netherlands )
  • Rommers, Nikki  ( University of Basel , Basel , Switzerland )
  • Balmer, Luzia  ( University Hospital Basel , Basel , Switzerland )
  • Fischer, Urs  ( Inselspital, University Hospital Be , Freiburgstrasse , Switzerland )
  • Psychogios, Marios  ( University Hospital Basel , Basel , Switzerland )
  • On Behalf Of The Distal Investigators, .  ( University Hospital Basel , Basel , Switzerland )
  • Rizzo, Federica  ( Hospital of Vall d'Hebron , Barcelona , Spain )
  • Strbian, Daniel  ( HUS, Neurocenter , Helsinki , Finland )
  • Raty, Silja  ( Helsinki University Hospital , Helsinki , Finland )
    • Author Disclosures:
    Aikaterini Anastasiou: DO NOT have relevant financial relationships | Juan Arenillas: DO have relevant financial relationships ; Research Funding (PI or named investigator):Spanish Ministry of Science:Active (exists now) ; Speaker:Medtronic:Past (completed) ; Advisor:Medtronic:Active (exists now) ; Advisor:BMS Pfizer:Past (completed) ; Advisor:Astra Zeneca:Past (completed) ; Research Funding (PI or named investigator):Astra Zeneca:Past (completed) ; Research Funding (PI or named investigator):Castilla y León Department of Health:Past (completed) | Mario Martínez-Galdámez: DO NOT have relevant financial relationships | Steven Hajdu: No Answer | Patrik Michel: DO have relevant financial relationships ; Research Funding (PI or named investigator):Swiss National Science Foundation:Active (exists now) ; Research Funding (PI or named investigator):Faculty of Biology and Medicine of the University of Lausanne:Past (completed) ; Research Funding (PI or named investigator):Swiss Heart Foundation:Active (exists now) | Jan Gralla: DO have relevant financial relationships ; Consultant:J&J:Active (exists now) ; Consultant:Medtronic:Past (completed) | Eike Piechowiak: DO NOT have relevant financial relationships | Daniel Kaiser: DO NOT have relevant financial relationships | Volker Puetz: No Answer | Frans R.A. Van den Bergh: DO NOT have relevant financial relationships | Sylvie De Raedt: DO NOT have relevant financial relationships | Helene Corbaz: No Answer | Flavio Bellante: DO NOT have relevant financial relationships | Anne DUSART: DO have relevant financial relationships ; Consultant:MIVI:Past (completed) | Victoria Hellstern: No Answer | Ali Khanafer: DO NOT have relevant financial relationships | Guillermo Parrilla: No Answer | Ana Morales: DO NOT have relevant financial relationships | Jan Kirschke: DO have relevant financial relationships ; Ownership Interest:Bonescreen GmbH:Active (exists now) ; Speaker:Novartis:Past (completed) | Silke Wunderlich: No Answer | Jens Fiehler: No Answer | Gotz Thomalla: No Answer | Alex Brehm: DO NOT have relevant financial relationships | Robin Lemmens: DO have relevant financial relationships ; Other (please indicate in the box next to the company name):iSchemaview: institutional fees for consulting:Active (exists now) | Jo Peluso: DO NOT have relevant financial relationships | Manuel Bolognese: DO have relevant financial relationships ; Advisor:Astra Zeneca:Past (completed) | Alexander von Hessling: DO NOT have relevant financial relationships | Adriaan van Es: DO NOT have relevant financial relationships | Nyika Kruyt: DO NOT have relevant financial relationships | Jonathan Coutinho: No Answer | Carlos Castano: DO NOT have relevant financial relationships | Jens Minnerup: No Answer | Wim van Zwam: DO have relevant financial relationships ; Speaker:Stryker:Active (exists now) ; Speaker:Nicolab:Past (completed) ; Speaker:Philips:Past (completed) ; Speaker:Cerenovus:Active (exists now) ; Speaker:Penumbra:Active (exists now) ; Speaker:Medtronic:Active (exists now) | Lioba Müller: DO NOT have relevant financial relationships | Elisabeth Dhondt: DO NOT have relevant financial relationships | Christian Nolte: DO NOT have relevant financial relationships | Paolo Machi: DO have relevant financial relationships ; Consultant:Medtronic:Active (exists now) ; Consultant:Penumbra:Active (exists now) ; Consultant:Microvention:Past (completed) ; Consultant:Biotronik:Active (exists now) ; Consultant:Stryker:Active (exists now) | Christian Loehr: DO NOT have relevant financial relationships | Heinrich Mattle: DO have relevant financial relationships ; Consultant:Medtronic:Active (exists now) ; Consultant:Stryker:Active (exists now) | Jan-Hendrik Buhk: No Answer | Johannes Kaesmacher: DO NOT have relevant financial relationships | Tomas Dobrocky: No Answer | Panagiotis Papanagiotou: No Answer | Angelika Alonso: DO NOT have relevant financial relationships | Evangelia Christodoulou: DO NOT have relevant financial relationships | Markus Holtmannspoetter: DO have relevant financial relationships ; Consultant:Microvention:Active (exists now) ; Consultant:Sim&Cure :Active (exists now) ; Consultant:Penox:Active (exists now) ; Consultant:Cerenovus:Active (exists now) ; Consultant:Balt:Active (exists now) ; Consultant:Penumbra:Active (exists now) ; Consultant:Stryker:Active (exists now) ; Consultant:Medtronic:Active (exists now) | Andrea Zini: DO have relevant financial relationships ; Advisor:Bayer:Active (exists now) ; Consultant:Astra-Zeneca:Past (completed) ; Speaker:Alexion:Past (completed) ; Speaker:Daiichi-Sankyo:Past (completed) ; Consultant:Astra-Zeneca:Past (completed) ; Speaker:Pfizer:Past (completed) ; Speaker:CSL Behring:Past (completed) ; Consultant:Boehringer-Ingelheim:Active (exists now) | Leonardo Renieri: DO NOT have relevant financial relationships | Fee Keil: No Answer | Ido van den Wijngaard: DO have relevant financial relationships ; Speaker:Medtronic:Past (completed) ; Advisor:Philips:Past (completed) | Georg Kaegi: DO NOT have relevant financial relationships | Isabel Fragata: No Answer | Mira Katan: DO have relevant financial relationships ; Advisor:BMS:Past (completed) ; Research Funding (PI or named investigator):BRAHMS Thermofisher Scientific:Active (exists now) ; Research Funding (PI or named investigator):Swiss National Science Foundation:Active (exists now) | Ronen Leker: DO NOT have relevant financial relationships | Jeffrey Saver: DO have relevant financial relationships ; Consultant:Abbott:Active (exists now) ; Individual Stocks/Stock Options:Viz.ai:Active (exists now) ; Individual Stocks/Stock Options:Let's Get Proof:Active (exists now) ; Individual Stocks/Stock Options:Neuronics:Active (exists now) ; Consultant:Genentech:Expected (by end of conference) ; Consultant:Roche:Active (exists now) ; Consultant:Novo Nordisc:Active (exists now) ; Consultant:AstraZeneca:Active (exists now) ; Consultant:BrainQ:Active (exists now) ; Consultant:Medtronic:Active (exists now) | Marc Ribo: DO NOT have relevant financial relationships | Julie Staals: DO have relevant financial relationships ; Speaker:Medtronic:Past (completed) | Nikki Rommers: DO NOT have relevant financial relationships | Luzia Balmer: DO NOT have relevant financial relationships | Urs Fischer: DO have relevant financial relationships ; Research Funding (PI or named investigator):Swiss National Science Foundation (fees paid to institution):Active (exists now) ; Other (please indicate in the box next to the company name):President Elect European Stroke Organisation:Active (exists now) ; Other (please indicate in the box next to the company name):President Swiss Neurological Society:Active (exists now) ; Consultant:Boehringer Ingelheim (fees paid to institution):Active (exists now) ; Consultant:CSL Behrling (fees paid to institution):Active (exists now) ; Consultant:Medtronic (fees paid to institution):Active (exists now) ; Research Funding (PI or named investigator):Boehringer Ingelheim (fees paid to institution):Active (exists now) ; Research Funding (PI or named investigator):Rapid Medical (fees paid to institution):Active (exists now) ; Research Funding (PI or named investigator):Phenox (fees paid to institution):Active (exists now) ; Research Funding (PI or named investigator):Penumbra (fees paid to institution):Active (exists now) ; Research Funding (PI or named investigator):Stryker (fees paid to institution):Active (exists now) ; Research Funding (PI or named investigator):Medtronic (fees paid to institution):Active (exists now) ; Research Funding (PI or named investigator):Swiss Heart Foundation (fees paid to institution):Active (exists now) | Marios Psychogios: DO have relevant financial relationships ; Research Funding (PI or named investigator):Penumbra Inc.:Active (exists now) ; Research Funding (PI or named investigator):Rapid Medical Inc.:Active (exists now) ; Research Funding (PI or named investigator):Phenox GmbH:Active (exists now) ; Research Funding (PI or named investigator):Stryker Neurovascular Inc.:Active (exists now) ; Research Funding (PI or named investigator):Medtronic Inc.:Active (exists now) ; Research Funding (PI or named investigator):Siemens Healthineers AG:Active (exists now) ; Speaker:Siemens Healthineers AG:Active (exists now) ; Speaker:Phenox GmbH:Active (exists now) ; Speaker:Penumbra Inc.:Active (exists now) ; Speaker:Medtronic Inc.:Active (exists now) ; Speaker:Stryker Neurovascular Inc.:Active (exists now) | . on behalf of the DISTAL investigators: No Answer | Federica Rizzo: DO NOT have relevant financial relationships | Daniel Strbian: DO NOT have relevant financial relationships | Silja Raty: DO NOT have relevant financial relationships
Meeting Info:

International Stroke Conference 2025

2025

Los Angeles, CA

Session Info:

Late-Breaking Science Oral Abstracts I

Wednesday, 02/05/2025 , 02:00PM - 03:00PM

Oral Abstract Session

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