Thrombectomy Not Routinely Supported for Medium- or Distal-Vessel Stroke: JAMA

A new study published in the Journal of the American Medical Association showed that thrombectomy was linked to an increased risk of bleeding and did not enhance clinical outcomes in individuals with acute ischemic stroke brought on by medium- or distal-vessel blockage. 

There is insufficient data on the effectiveness and safety of thrombectomy in cases of acute ischemic stroke (AIS) brought on by medium or distal vascular occlusions (MDVOs). Thus, this study determined whether individuals with an AIS associated with a main and isolated MDVO would benefit more from thrombectomy in addition to medical treatment than from medical treatment alone.

488 individuals are expected to be enrolled in this randomized clinical study, which will take place at 22 stroke clinics in France between November 2021 and April 2025. Following the scheduled interim analysis, the experiment was discontinued due to futility and an increased risk of symptomatic cerebral bleeding following thrombectomy, as recommended by the data and safety monitoring board.

If there was no hyperintense signal on fluid-attenuated inversion recovery imaging, eligible adult patients experienced an AIS caused by a main MDVO within 8 hours of the beginning of symptoms or within 24 hours of their last well-being.

A modified Rankin Scale score of 0 to 2, determined by an impartial, blinded assessor, was the main outcome measure at three months. Adverse and major adverse events, as well as the mortality rate at 3 months, were secondary end goals.

Of the 244 patients who were randomly assigned, 217 (89%) of the 123 patients in the thrombectomy group (81%) underwent follow-up, whereas none of the 121 patients in the control group (81%) had thrombectomy. 

When compared to 81 of 119 patients (68%) in the control group, 72 of 116 patients (62%) in the thrombectomy group had a favorable clinical result at three months. 

The 100 patients who had thrombectomy had higher rates of symptomatic intracranial hemorrhages (11% vs. 3%, P =.008), subarachnoid hemorrhages (13% vs. 2%, P <.001), and embolus migration (5% vs. 1%, P =.04). 

The two groups' mortality rates did not differ substantially (6% vs. 8%; P =.49).

Overall, in patients with acute ischemic stroke associated with an MDVO, thrombectomy did not result in a better incidence of favorable clinical outcome at 3 months as compared to medical therapy alone. Following thrombectomy, hemorrhagic complications were more common.

Reference:

Clarençon, F., Bala, F., Baptiste, A., Pasi, M., Marnat, G., Sibon, I., Gory, B., Richard, S., Pop, R., Wolff, V., Fauché, C., Lamy, M., Costalat, V., Arquizan, C., Rodriguez-Régent, C., Turc, G., Cognard, C., Fontaine, L., Di Maria, F., … DISCOUNT Investigators. (2026). Mechanical thrombectomy in ischemic stroke with a medium or distal arterial occlusion: The DISCOUNT randomized clinical trial: The DISCOUNT randomized clinical trial. The Journal of the American Medical Association. https://doi.org/10.1001/jama.2026.8977