In this exploratory pooled analysis of minor stroke (NIHSS ≤5) with anterior large vessel occlusion, EVT and IVT had similar excellent functional outcomes overall, but the association differed by occlusion site: EVT was numerically better for ICA/MCA-M1 occlusions and worse for MCA-M2 occlusions.
Key Findings
Results
Overall, EVT and IVT showed no significant difference in excellent functional outcome (mRS 0-1 at 90 days) in minor stroke patients with anterior LVO.
237 patients were pooled from the DETECT2-China study and the EAST trial: 105 (44.3%) received IVT and 132 (55.7%) received EVT.
Excellent functional outcome was 73.5% vs. 75.2% (EVT vs. IVT, as implied by the aOR direction), aOR = 0.749, 95% CI 0.392-1.433, p = 0.383.
Inclusion required NIHSS ≤5 and occlusion of the ICA, MCA-M1 or MCA-M2.
Results
Symptomatic intracranial hemorrhage (sICH) was numerically higher with EVT than with IVT, but the difference was not statistically significant.
sICH was 1.9% vs. 6.1% (IVT vs. EVT, as implied by the group sizes and the aOR direction).
aOR = 4.158, 95% CI 0.819-21.127, p = 0.086.
The wide confidence interval reflects the small number of events.
Results
In patients with ICA or MCA-M1 occlusion, EVT was associated with numerically higher odds of excellent functional outcome than IVT, though not significantly.
Excellent outcome was 79.4% with EVT vs. 67.2% with IVT.
aOR = 1.491, 95% CI 0.693-3.211, p = 0.307.
Results
In patients with MCA-M2 occlusion, EVT was associated with a significantly lower probability of excellent functional outcome than IVT.
Excellent outcome was 53.3% with EVT vs. 86.4% with IVT.
aOR = 0.250, 95% CI 0.057-0.980, p = 0.050, a borderline result.
This was a subgroup analysis in a small sample.
Results
A significant interaction was found between treatment (EVT vs. IVT) and occlusion site for excellent functional outcome.
p for interaction = 0.008.
Interactions were tested with terms in logistic regression models, and analyses were then repeated separately for ICA/MCA-M1 and MCA-M2 occlusions.
Conclusions
The authors characterize the findings as exploratory: the association between reperfusion strategy and outcome differed by occlusion site.
Proximal occlusions (ICA/MCA-M1) in the EVT cohort had numerically better outcomes.
M2 occlusions in the EVT cohort had worse outcomes than in the IVT cohort.
The cohort was pooled from an observational study and a trial, and the analysis was adjusted (aOR) rather than randomized.
What This Means
This study looked at people who had a mild stroke (low stroke severity scores) caused by a blockage in a large artery in the front part of the brain. It compared two treatments: endovascular treatment (EVT), in which doctors physically remove the clot with a catheter, and intravenous thrombolysis (IVT), a clot-dissolving drug. Researchers pooled data on 237 patients from two earlier studies. About 74-75% in each group recovered with little or no disability at 90 days, so overall there was no clear difference between the treatments.
The picture changed when the researchers looked at where the clot was. For blockages in the larger, more proximal arteries (the internal carotid artery or the first segment of the middle cerebral artery), patients who had EVT did somewhat better (79% vs. 67%), though this could have been due to chance. For blockages in a smaller, more distal branch (the M2 segment), patients who had EVT did worse than those given the drug (53% vs. 86%). Bleeding in the brain was also numerically more common with EVT (6.1% vs. 1.9%), but the numbers were too small to be sure.
This research suggests that the best treatment for mild stroke with a large vessel blockage may depend on the clot's location. However, the study was small, the subgroup groups were smaller still, and the authors describe it as exploratory. The findings point to a question for larger, dedicated trials rather than settling which treatment is better.
Xing G, Li X, Wang T, Chen H. (2026). Association of endovascular treatment versus intravenous thrombolysis in mild stroke across occlusion subgroups.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1878069