Abstract Number: Esoc2026a1091 Endovascular Treatment for Medium and Distal Vessel Occlusion Stroke: Are We Missing the Point?

Abstract Background and aims Endovascular treatment (EVT) with best medical management for distal/medium vessel occlusion (DMVO) stroke treatment failed to improve disability-related outcomes and was associated with a trend toward worse safety outcomes in three randomized controlled trials (RCT) recently presented. Our aim was to compare baseline characteristics of patients with DMVO stroke treated in routine clinical practice and those enrolled in RCT. Methods We conducted a retrospective comparative study using a prospectively recorded, dual-center, database of patients. We included all consecutive patients with an AIS due to isolated primary DMVO (distal/non-dominant M2, M3, A2, A3, P1, P2) who underwent EVT and/or were randomized into a distal occlusion RCT from January 2022 to July 2024. Patients were categorized as receiving EVT under routine clinical practice (RP group) or enrolled in a RCT for DMVO stroke (CT group). Results A total of 182 patients with an AIS due to isolated DMVO were included: median age was 79 (IQR 69-86) years, 84 (46.2%) patients were female, and the median baseline mRS was 1 (IQR 0-2). Fifty-three patients (29.1%) were in the CT group, and 129 (70.9%) in the RP group. CT patients showed less vascular risk factors (2IQR 1-3 vs 11-2; p=0.062), lower baseline NIHSS score (54-7 vs 107-15; p0.001), and lower median hypoperfusion volume (Tmax6s) on admission CTP (2716-42 vs 4824-70; p0.001). Conclusions Our study highlights potential selection bias in RCTs involving DMVO stroke, where milder stroke-patients were included. These differences may limit the generalizability of RCT findings. Conflict of interest Ane Murillo: nothing to disclose Table 1 - belongs to Results