Endovascular Treatment of Medium

Endovascular Treatment of Medium-Vessel-Occlusion Strokes Published May 13, 2026 N Engl J Med 2026;394:1894-1904 DOI: 10.1056/NEJMoa2514120 Abstract Background Endovascular thrombectomy for acute ischemic stroke due to medium-vessel occlusion has had varying results across trials. Whether thrombectomy improves functional outcomes in patients with medium-vessel occlusion and moderate-to-severe deficits is unclear. Methods We conducted an open-label, randomized trial with blinded outcome assessment at 48 centers in China. Eligible patients were adults who presented within 24 hours after the onset of a moderate-to-severe stroke (National Institutes of Health Stroke Scale [NIHSS] score, ≥6; scale, 0 to 42, with higher scores indicating greater neurologic deficits) due to occlusion of a medium vessel. Patients were assigned in a 1:1 ratio to thrombectomy plus medical management (thrombectomy group) or medical management alone (control group). The primary outcome was functional disability as measured by the shift in the modified Rankin scale score (scale, 0 [no disability] to 6 [death]) at 90 days. Violation of the proportional-odds assumption precluded the use of shift in the modified Rankin scale score, so as prespecified, functional independence (modified Rankin scale score of 0, 1, or 2) at 90 days was used as the primary outcome. Safety outcomes were symptomatic intracranial hemorrhage and 90-day mortality. Results Among 280 patients in the thrombectomy group and 283 in the control group, the median age was 71 years, the median NIHSS score was 10 (range, 3 to 36), and 42.8% were women; 36.6% received intravenous thrombolysis. Functional independence at 90 days was seen in 58.6% of the patients in the thrombectomy group and in 46.6% of those in the control group (adjusted rate ratio, 1.24; 95% confidence interval, 1.07 to 1.44; P=0.004). The incidence of symptomatic intracranial hemorrhage was 4.7% in the thrombectomy group and 2.2% in the control group; 90-day mortality was 11.1% and 10.2%, respectively. Conclusions Among patients with acute ischemic stroke due to medium-vessel occlusion and moderate-to-severe deficits, thrombectomy led to a greater likelihood of functional independence than medical management alone but also to a higher risk of symptomatic intracranial hemorrhage. (Funded by the National Natural Science Foundation of China and the Noncommunicable Chronic Diseases–National Science and Technology Major Project; ORIENTAL-MeVO ClinicalTrials.gov number, NCT06146790.) Are you a member of an institution such as a university or hospital?Learn more about Institutional Access Notes A data sharing statement provided by the authors is available with the full text of this article at NEJM.org. Supported by a grant (82471311) from the National Natural Science Foundation of China and by the Noncommunicable Chronic Diseases–National Science and Technology Major Project (2024ZD0527903). Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Supplementary Material Information & Authors Information Published In Copyright Copyright © 2026 Massachusetts Medical Society. All rights reserved. For personal use only. Any commercial reuse of NEJM Group content requires permission. History Published online: May 13, 2026 Published in issue: May 14, 2026 Topics - Cardiology General - Clinical Medicine General - Critical Care - Emergency Medicine General - Geriatrics/Aging General - Hospital-Based Clinical Medicine - Neurology/Neurosurgery General - Peripheral Arterial and Aortic Disease - Pulmonary/Critical Care General - Radiology General - Stroke (Emergency Medicine) - Stroke (Neurology/Neurosurgery) Authors Metrics & Citations Metrics Altmetrics Citations Export citation Select the format you want to export the citation of this publication. Cited by - Endovascular Therapy for Medium-Vessel Occlusion Stroke — Narrowing the Target Population, New England Journal of Medicine, 394, 19, (1955-1957), (2026)./doi/full/10.1056/NEJMe2601852 Loading...