Endovascular Therapy Plus BMT Improves Imaging and Clinical Outcomes in Medium- or Distal-Vessel Occlusion Stroke: JAMA
Switzerland: A post hoc analysis of the DISTAL trial found that endovascular therapy (EVT) combined with best medical treatment (BMT) increased the likelihood of achieving favorable imaging outcomes compared to BMT alone in medium- or distal-vessel occlusion stroke. Additionally, better imaging outcomes were linked to improved clinical outcomes in both groups.
These findings were reported in JAMA Neurology by Aikaterini Anastasiou from the Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, University of Basel, Switzerland, and colleagues. The study highlights the growing role of imaging-based endpoints in assessing the effectiveness of stroke interventions, particularly in smaller or more distal vessels, where treatment benefits are still being defined.
Medium- and distal-vessel occlusion strokes represent a substantial proportion of ischemic strokes, yet the optimal management approach remains under investigation. While EVT has shown clear benefits in large-vessel occlusions, its utility in smaller vessel occlusions is less certain. In this context, the researchers examined whether adding EVT to standard medical therapy could better preserve brain tissue at risk, as assessed through advanced imaging techniques.
The analysis was based on data from the DISTAL trial, a multicenter randomized clinical study conducted across 55 hospitals in 11 countries between December 2021 and July 2024. A total of 447 patients with available baseline perfusion imaging and follow-up scans at 24 hours were included. Of these, 226 patients received EVT in addition to BMT, while 221 were treated with BMT alone. Clinical outcomes were assessed at 90 days.
The primary outcome focused on the proportion of threatened brain tissue that was preserved, calculated by comparing the initial volume at risk with the final infarct size. A favorable imaging outcome was defined as preservation of at least 80% of the initially at-risk tissue within 24 hours.
The following were the key findings:
- Patients receiving EVT plus BMT were more likely to achieve a favorable imaging outcome compared to those on BMT alone.
- Greater preservation of brain tissue was observed in the EVT group.
- Favorable imaging outcomes were associated with better functional recovery.
- Higher tissue preservation was linked to lower rates of disability and dependence at 90 days, irrespective of treatment group.
- Successful reperfusion showed a strong association with improved imaging outcomes.
These findings highlight the importance of timely restoration of blood flow in acute stroke management.
Overall, the findings suggest that EVT, when added to standard medical treatment, may offer additional benefits in preserving brain tissue in patients with medium- or distal-vessel occlusion stroke. The study also underscores the value of imaging-based measures as meaningful indicators of treatment success. The authors note that incorporating such endpoints could enhance the evaluation of therapeutic strategies and guide clinical decision-making in this evolving area of stroke management.
Reference:
Anastasiou A, Corbaz H, Christodoulou E, et al. Mechanical Thrombectomy and Final Infarct Volume in Medium or Distal Vessel Occlusion Stroke: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Neurol. Published online April 20, 2026. doi:10.1001/jamaneurol.2026.0805
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