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 This retrospective summary may be superseded by later evidence or guidance.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 of Stroke Due to Medium-Vessel Occlusion

Mayank Goyal, Johanna M Ospel, Aravind Ganesh, Dar Dowlatshahi, David Volders, Markus A Möhlenbruch, Mouhammad A Jumaa, Shahid M Nimjee, Thomas C Booth, Brian H Buck, James Kennedy, Jai J Shankar, Franziska Dorn, Liqun Zhang, Christian Hametner, Sandor Nardai, Atif Zafar, William Diprose, Shabnam Vatanpour, Alexander Stebner, Salome Bosshart, Nishita Singh, Ivy Sebastian, Kazutaka Uchida, Karla J Ryckborst, Robert Fahed, Sherry X Hu, Dominik F Vollherbst, Syed F Zaidi, Vivien H Lee, Jeremy Lynch, Jeremy L Rempel, Rachel Teal, Anurag Trivedi, Felix J Bode, Ayokunle Ogungbemi, Mirko Pham, Peter Orosz, Mohamad Abdalkader, Christian Taschner, Jason Tarpley, Sven Poli, Ravinder-Jeet Singh, Reade De Leacy, George Lopez, Demetrios Sahlas, Michael Chen, Paul Burns, Joanna D Schaafsma, Richard Marigold, Arno Reich, Adewumi Amole, Thalia S Field, Richard H Swartz, Fabio Settecase, Gábor Lenzsér, Santiago Ortega-Gutierrez, Negar Asdaghi, Kyriakos Lobotesis, Adnan H Siddiqui, Joerg Berrouschot, Maxim Mokin, Koji Ebersole, Hauke Schneider, Albert J Yoo, Jennifer Mandzia, Jesse Klostranec, Changez Jadun, Tufail Patankar, Eric Sauvageau, Robert Lenthall, Lissa Peeling, Thien Huynh, Ronald Budzik, Seon-Kyu Lee, Levansri Makalanda, Michael R Levitt, Richard J Perry, Thant Hlaing, Babak S Jahromi, Paul Singh, Andrew M Demchuk, Michael D Hill, ESCAPE-MeVO InvestigatorsMayank Goyal, Johanna M Ospel, Aravind Ganesh 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

ESCAPE-MeVO randomized 530 patients with medium-vessel ischemic stroke and favorable imaging within 12 hours to EVT plus usual care or usual care alone. Excellent 90-day outcome occurred in 41.6% versus 43.1% (adjusted rate ratio 0.95; 95% CI 0.79–1.15). Mortality and symptomatic intracranial hemorrhage were numerically higher with EVT.

Why it matters

Routine thrombectomy for this medium-vessel population was not supported. The result should inform stroke-center transfer discussions without delaying assessment for established reperfusion indications.

Study at a glance

Design: Randomized trial
Population: Imaging-selected medium-vessel occlusion stroke within 12 hours in five countries.
Sample size: 530
Intervention: EVT plus usual care.
Comparator: Usual care alone.
Primary endpoint: Modified Rankin Scale 0–1 at 90 days.

Main findings

Mortality: 13.3% versus 8.4%; adjusted HR 1.82 (95% CI 1.06–3.12).
Symptomatic intracranial hemorrhage: 5.4% versus 2.2%.

Limitations

Open-label treatment with blinded outcomes; 84.7% had MCA-branch occlusions. The trial does not exclude benefit in an unidentified subgroup or address all future devices.

Read the primary source

Full text: Abstract available; full text paywalled.

Original source

DOI: 10.1056/NEJMoa2411668

PMID: 39908448

Material reviewed: abstract.

Source retrieved Oct 27, 2026. Historical backfill: first-online date verified from the PubMed electronic publication record. Abstract reviewed; full text unavailable. This is historical evidence, not a new 2026 publication.

Neurology & stroke

Corrections & review history

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