ISC 2025 | Endovascular therapy in medium vessel occlusion stroke: findings from the DISTAL trial

Urs Fischer

We know that endovascular therapy is highly effective in people with large vessel occlusion stroke. However, we do not know whether endovascular therapy also works for people with medium or distal vessel occlusion. And that was the rationale why we designed to do a trial, the so-called DISTAL trial, randomizing people with medium or vessel occlusion into endovascular therapy plus best medical treatment versus best medical treatment alone. What we know from the literature that even though these people have smaller arteries which are blocked in the brain, the outcome is not as good as expected. So we randomized more than 500 people and what we saw in the results of the DISTAL trial that there was no significant difference in between the two treatment arms. There was no sign of harm. Nevertheless, the overall outcome was again not as good as we would expect it. So only 55% of patients in both treatment arms are independent after the stroke and 45% of these people remain with a handicap or even die.

Marios Psychogios

The next steps of the trial is more of the presentation and the paper is going to go online in the New England Journal of Medicine. I think it’s important to pool the data with the other trials that are going to be also announced and published tomorrow, the ESCAPE-MeVO and the DISCOUNT trial. And then in an IPDMA level, so independent patient meta-analysis, try to identify groups of patients that may show benefits for endovascular treatment because, as Urs said, we haven’t found that we are harming patients with the treatment. And obviously an open vessel should be better than one that you know is still closed. So this is the rationale behind going with the catheter with a stent and trying to open the vessel but still in the overall population at the moment we are not improving clinical outcome so what we have to do is to try and find the subgroups that probably will benefit from treatment and then maybe plan the future trials.

Urs Fischer

I think to finish I would like to thank all the people who helped us to do such a trial. Running randomized control trials is a huge endeavor and we are extremely grateful to the patients and their families, all the investigators, the committees but also the study team who helped us to do that trial. Alone it would not have been possible to run such a randomized controlled trial.

Marios Psychogios

Also from my point of view a great great thank you to all the patients and their families that consented and supported the trial but also we have to thank our great supporters and also the Swiss National Foundation that helped us fund the study and also the companies that supported us with unrestricted grants for running the trial. So a big thank you. And in the end, I think it’s also a sign that we are both sitting here and discussing this as a group that I think to be successful in such trials, it’s important to perform in such a group of neurologists and neuro-interventionalists.

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