DISTAL
Trial question
What is the role of endovascular treatment in patients with AIS due to medium or distal vessel occlusion?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
44.0% female
56.0% male
N = 543
543 patients (239 female, 304 male).
Inclusion criteria: adult patients with AIS due to medium or distal vessel occlusion.
Key exclusion criteria: acute ICH; bedridden or nursing home resident; in-hospital stroke; known sensitivity to radiographic contrast agents, nickel, titanium metals or their alloys; pregnancy or lactation; evidence of cerebral vasculitis; evidence of vessel recanalization prior to randomization.
Interventions
N=271 endovascular therapy (endovascular treatment device and technique choice made by the treating physician plus best medical treatment).
N=272 usual care (best medical treatment including intravenous thrombolysis or antiplatelet therapy if indicated under current international guidelines and according to routine clinical practice).
Primary outcome
Median modified Rankin Scale score at day 90
2 points
2 points
2.0 points
1.5 points
1.0 points
0.5 points
0.0 points
Endovascular
therapy
Usual
care
No significant
difference ↔
No significant difference in median mRS score at day 90 (2 points vs. 2 points; OR 0.9, 95% CI 0.67 to 1.22).
Secondary outcomes
No significant difference in excellent functional outcome at day 90 (34.7% vs. 37.5%; OR 0.88, 95% CI 0.61 to 1.25).
No significant difference in improvement in severity of neurologic deficit at 24 hours (0.4 points vs. 0.3 points; MD 0.02, 95% CI -0.1 to 0.14).
No significant difference in cognitive function (23 points vs. 23 points; MD 0.13, 95% CI -1.22 to 1.48).
Safety outcomes
No significant differences in death at day 90, symptomatic ICH within 24 hours.
Conclusion
In adult patients with AIS due to medium or distal vessel occlusion, endovascular therapy was not superior to usual care with respect to median mRS score at day 90.
Reference
Marios Psychogios, Alex Brehm, Marc Ribo et al. Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels. N Engl J Med. 2025 Apr 10;392(14):1374-1384.
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