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WSC 2022 | EVT as a treatment for MeVO: current guidelines and new studies

Nishita Singh, MD, University of Calgary, Calgary, Alberta, Canada, addresses the current guidelines for treating acute ischemic strokes caused by medium vessel occlusion (MeVO). Current guidelines only recommend endovascular thrombectomy (EVT) for large vessel occlusion, although many physicians also treat proximal M2 occlusions with EVT given the supportive literature. Several trials are underway to provide more robust data in this patient population. The ESCAPE-MeVO trial (NCT05151172) will randomize over 500 patients with acute stroke due to MeVO to receive standard of care or standard of care plus thrombectomy within 12 hours of symptom onset. The DISTAL trial (NCT05029414) is also evaluating the clinical efficacy of EVT plus best medical treatment after an isolated MeVO stroke, compared to best medical treatment alone. The data from these trials could potentially help to change the guidelines for EVT. Currently, the biggest challenge for randomizing patients with MeVOs in trials is that many physicians would already treat these patients with EVT. Furthermore, some MeVO patients have relatively minor deficits, therefore it is difficult to determine what would be a good primary outcome and what would be a significant enough effect size to change the guidelines. This interview took place at the World Stroke Congress 2022 in Singapore.

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