International Stroke Conference 2025  /  Opening Main Event  /  Endovascular therapy plus best medical treatment versus best medical treatment alone for medium distal vessel occlusion stroke: The DISTAL Trial
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American Heart Association

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Final ID: LB3

Endovascular therapy plus best medical treatment versus best medical treatment alone for medium distal vessel occlusion stroke: The DISTAL Trial

Abstract Body: Endovascular therapy plus best medical treatment versus best medical treatment alone for medium distal vessel occlusion stroke

BACKGROUND
We aimed to determine whether in people with an acute ischemic stroke (AIS) due to a medium distal vessel occlusion (MDVO) endovascular therapy (EVT) in addition to best medical treatment (BMT) results in a superior functional outcome compared to BMT alone.
HYPOTHESIS
We hypothesized that EVT in addition to BMT compared to BMT alone leads to a lower level of dependency and disability in daily activities.
METHODS
We performed an investigator-initiated, international, multicenter, randomized, open-label, assessor-blinded trial at 61 sites in 11 countries. Patients were randomly assigned 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. The primary outcome was the degree of disability and dependency in daily activities as measured with the modified Rankin Scale (mRS) at 90 days. The treatment effect was estimated with ordinal logistic regression as a common odds ratio, adjusted for prespecified factors. The adjusted common odds ratio measured the likelihood that EVT in addition to BMT would lead to lower modified Rankin scores (shift analysis).
RESULTS
A total of 543 patients (44% female, mean age 74.8 years) were assigned to either EVT plus BMT (271 patients) or to BMT alone (272 patients). The median National Institute of Health Stroke Scale at admission was 4 (Interquartile Range 2–8). Approximately 66% of the patients received intravenous thrombolysis. Prestroke mRS was 0 in 63.2%, 1 in 17%, 2 in 11.5% of the population, while 8.3% of the patients had a prestroke mRS of 3-4. Predominant occlusion locations were the M2 (44.2%), M3 (26.8%), P2 (13.5%) and P1 (5.5%) segment. Final efficacy and safety results were not available at the time of drafting this abstract. The results will be available at the ISC 2025.
CONCLUSION
Results will be available at ISC 2025.


ClinicalTrials.gov Identifier: NCT05029414
  • Psychogios, Marios  ( University Hospital Basel , Basel , Switzerland )
  • Michel, Patrik  ( CHUV , Lausanne , Switzerland )
  • Gralla, Jan  ( Inselspital, University Hospital Bern , Freiburgstrasse , Switzerland )
  • Piechowiak, Eike  ( Inselspital, University Hospital Bern , Freiburgstrasse , Switzerland )
  • Kaiser, Daniel  ( University Clinics Dresden , Dresden , Germany )
  • Puetz, Volker  ( University Clinics Dresden , Dresden , Germany )
  • Van Den Bergh, Frans R.a.  ( UZ Brussel , JETTE , Belgium )
  • De Raedt, Sylvie  ( UZ Brussel , JETTE , Belgium )
  • Bellante, Flavio  ( Hôpital Civil Marie Curie , Charleroi , Belgium )
  • Dusart, Anne  ( Hôpital Civil Marie Curie , Charleroi , Belgium )
  • Hellstern, Victoria  ( University Hospital Stuttgart , Stuttgart , Germany )
  • Brehm, Alex  ( University Hospital Basel , Basel , Switzerland )
  • Khanafer, Ali  ( University Hospital Stuttgart , Stuttgart , Germany )
  • Parrilla, Guillermo  ( Hospital Virgen de la Arrixaca , Murcia , Spain )
  • Morales, Ana  ( 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 , Hamburg , Germany )
  • Thomalla, Gotz  ( University Medical Center Hamburg , Hamburg , Germany )
  • Lemmens, Robin  ( UNIVERSITY HOSPITALS LEUVEN , Leuven , Belgium )
  • Peluso, Jo  ( UNIVERSITY HOSPITALS LEUVEN , Leuven , Belgium )
  • Bolognese, Manuel  ( Luzerner Kantonsspital , Lucerne , Switzerland )
  • Ribo, Marc  ( HOSPITAL VALL D HEBRON , Barcelona , Spain )
  • Von Hessling, Alexander  ( Luzerner Kantonsspital , Lucerne , Switzerland )
  • Van Es, Adriaan  ( Leiden University Medical Centre , Leiden , Netherlands )
  • Kruyt, Nyika  ( Leiden University Medical Centre , Leiden , Netherlands )
  • Coutinho, Jonathan  ( Amsterdam University Medical Centers , Amsterdams , Netherlands )
  • Castano, Carlos  ( Hospital Germans Trias i Pujol , Badalona Barcelona , Spain )
  • Minnerup, Jens  ( University of Münster , Münster , Germany )
  • Van Zwam, Wim  ( MUMC , Maastricht , Netherlands )
  • Dhondt, Elisabeth  ( UZ Gent , Gent , Belgium )
  • Nolte, Christian  ( Charite Berlin , Berlin , Germany )
  • Machi, Paolo  ( University Hospital Geneva , Geneva , Switzerland )
  • Rizzo, Federica  ( Univeristy Hospital of Vall d'Hebro , Barcelona , Spain )
  • Loehr, Christian  ( Klinikum Vest, Recklinghausen , Recklinghausen , Germany )
  • Mattle, Heinrich  ( UNIVERSITY OF BERN , Bern , Switzerland )
  • Buhk, Jan-hendrik  ( Asklepios hospitals St. Georg and Wandsbeck , Hamburg , Germany )
  • Kaesmacher, Johannes  ( Inselspital, University Hospital Bern , Freiburgstrasse , Switzerland )
  • Dobrocky, Tomas  ( Inselspital, University Hospital Bern , Freiburgstrasse , Switzerland )
  • Papanagiotou, Panagiotis  ( Klinikum Bremen-Mitte , Bremen , Germany )
  • Alonso, Angelika  ( Universitätsmedizin Mannheim , Mannheim , Germany )
  • Holtmannspoetter, Markus  ( Hospital Nuremberg-South Campus , Nuremberg , Germany )
  • Zini, Andrea  ( IRCCS Istituto delle Scienze Neurol , Bologna , Italy )
  • Renieri, Leonardo  ( Careggi University Hospital , Florence , Italy )
  • Strbian, Daniel  ( HELSINKI UNIVERSITY HOSPITAL , Helsinki , Finland )
  • Keil, Fee  ( University Hospital Frankfurt , Frankfurt , Germany )
  • Van Den Wijngaard, Ido  ( Haaglanden Medical Center , Haaglanden , Netherlands )
  • Kaegi, Georg  ( Kantonsspital St. Gallen , St. Gallen , Switzerland )
  • Terceno, Mikel  ( University Hospital Girona , Girona , Spain )
  • Wiesmann, Martin  ( University Hospital RWTH Aachen , Aachen , Germany )
  • Amaro, Sergio  ( Hospital Clinic de Barcelona , Barcelona , Spain )
  • Fragata, Isabel  ( Rua Dr Augusto Jose da Cunha , Alges , Portugal )
  • Katan, Mira  ( University Hospital Basel , Basel , Switzerland )
  • Leker, Ronen  ( HEBREW UNIVERSITY-HADASSAH MEDICAL , Jerusalem , Israel )
  • Saver, Jeffrey  ( GEFFEN SCHOOL OF MEDICINE AT UCLA , Los Angeles , California , United States )
  • Raty, Silja  ( Helsinki University Hospital , Helsinki , Finland )
  • Staals, Julie  ( MUMC , Maastricht , Netherlands )
  • Rommers, Nikki  ( University of Basel , Basel , Switzerland )
  • Balmer, Luzia  ( University Hospital Basel , Basel , Switzerland )
  • Fischer, Urs  ( Inselspital, University Hospital Bern , Freiburgstrasse , Switzerland )
  • On Behalf Of The Distal Investigators, .  ( University Hospital Basel , Basel , Switzerland )
  • Arenillas, Juan  ( HOSPITAL CLINICO UNIV VALLADOLID , Valladolid , Spain )
  • Martínez-galdámez, Mario  ( HOSPITAL CLINICO UNIV VALLADOLID , Valladolid , Spain )
  • Hadju, Steven  ( CHUV , Lausanne , Switzerland )
    • Author Disclosures:
    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) | 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: DO NOT have relevant financial relationships | Frans R.A. Van den Bergh: DO NOT have relevant financial relationships | Sylvie De Raedt: DO NOT have relevant financial relationships | Flavio Bellante: No Answer | Anne DUSART: DO have relevant financial relationships ; Consultant:MIVI:Past (completed) | Victoria Hellstern: No Answer | Alex Brehm: DO NOT have relevant financial relationships | Ali Khanafer: DO NOT have relevant financial relationships | Guillermo Parrilla: DO NOT have relevant financial relationships | 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 | 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) | Marc Ribo: DO NOT have relevant financial relationships | 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) | 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) | Federica Rizzo: DO NOT have relevant financial relationships | 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: DO have relevant financial relationships ; Consultant:MicroVention:Active (exists now) ; Consultant:eVasc:Active (exists now) ; Consultant:Medtronic:Past (completed) ; Consultant:Vesalio:Past (completed) ; Consultant:Stryker:Active (exists now) | Johannes Kaesmacher: DO NOT have relevant financial relationships | Tomas Dobrocky: No Answer | Panagiotis Papanagiotou: No Answer | Angelika Alonso: 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 | Daniel Strbian: 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 | Mikel Terceno: No Answer | Martin Wiesmann: DO NOT have relevant financial relationships | Sergio Amaro: 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) | Silja Raty: 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) | . on behalf of the DISTAL investigators: No Answer | 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 Hadju: No Answer
Meeting Info:

International Stroke Conference 2025

2025

Los Angeles, CA

Session Info:

Opening Main Event

Wednesday, 02/05/2025 , 11:00AM - 12:35PM

ISC Invited Symposium

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