EM Weekly.Emergency medicine literature

Historical collection · First published Feb 5, 2025; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.

Randomized trialNew England Journal of Medicine

Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels

Marios Psychogios, Alex Brehm, Marc Ribo, Federica Rizzo, Daniel Strbian, Silja Räty, Juan F Arenillas, Mario Martínez-Galdámez, Steven D Hajdu, Patrik Michel, Jan Gralla, Eike I Piechowiak, Daniel P O Kaiser, Volker Puetz, Frans Van den Bergh, Sylvie De Raedt, Flavio Bellante, Anne Dusart, Victoria Hellstern, Ali Khanafer, Guillermo Parrilla, Ana Morales, Jan S Kirschke, Silke Wunderlich, Jens Fiehler, Götz Thomalla, Robin Lemmens, Jo P Peluso, Manuel Bolognese, Alexander von Hessling, Adriaan van Es, Nyika D Kruyt, Jonathan M Coutinho, Carlos Castaño, Jens Minnerup, Wim van Zwam, Elisabeth Dhondt, Christian H Nolte, Paolo Machi, Christian Loehr, Heinrich P Mattle, Jan-Hendrik Buhk, Johannes Kaesmacher, Tomas Dobrocky, Panagiotis Papanagiotou, Angelika Alonso, Markus Holtmannspoetter, Andrea Zini, Leonardo Renieri, Fee Keil, Ido van den Wijngaard, Georg Kägi, Mikel Terceño, Martin Wiesmann, Sergio Amaro, Nikki Rommers, Luzia Balmer, Isabel Fragata, Mira Katan, Ronen R Leker, Jeffrey L Saver, Julie Staals, Urs Fischer, DISTAL InvestigatorsMarios Psychogios, Alex Brehm, Marc Ribo et al.

First online Feb 5, 2025On EM Weekly Oct 27, 2026Discovered Oct 27, 2026AI-generated Not yet human-reviewed

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Summary

DISTAL randomized 543 patients with selected medium/distal intracranial occlusions to EVT plus medical care or medical care alone within 24 hours. Ninety-day disability did not improve (common OR 0.90; 95% CI 0.67–1.22; P=.50). Symptomatic intracranial hemorrhage occurred in 5.9% versus 2.6%.

Why it matters

Do not extend the established benefit of large-vessel thrombectomy automatically to these distal occlusions. Continue urgent stroke assessment and eligible medical reperfusion treatment.

Study at a glance

Design: Randomized trial
Population: Patients with isolated eligible MCA, ACA or PCA medium/distal occlusions.
Sample size: 543
Intervention: EVT plus best medical treatment.
Comparator: Best medical treatment alone.
Primary endpoint: Distribution of modified Rankin Scale scores at 90 days.

Main findings

Mortality: 15.5% versus 14.0%.
IV thrombolysis was used in 65.4%.

Limitations

Median NIHSS was 6 and eligible occlusion locations were specified, including nondominant/codominant M2. Results do not settle every vessel, severity or device subgroup.

Read the primary source

Full text: Open-access full text available.

Original source

DOI: 10.1056/NEJMoa2408954

PMID: 39908430

Material reviewed: abstract.

Source retrieved Oct 27, 2026. Historical backfill. Primary PubMed abstract and electronic date reviewed; full text was not reviewed. PubMed labels this a free article and links a legal University of Liege repository copy. Do not infer full-text appraisal from availability.

Neurology & stroke

Corrections & review history

No corrections recorded. Human review: not yet human-reviewed.