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We appraise randomized and real-world evidence and ask whether, and in whom, MeVO should be treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recent Findings<\/jats:title>\n                    <jats:p>DISTAL, ESCAPE-MeVO and DISCOUNT found no functional benefit from adding EVT to medical treatment, with more hemorrhage and serious adverse events; DISTAL\u2019s 12-month results were also neutral. ORIENTAL-MeVO, restricted to deficits of NIHSS\u2009\u2265\u20096 within 24\u00a0h, reported greater functional independence with EVT (58.6% versus 46.6%). The MEMENTO registry (164 patients, 15 Middle East and North Africa centres) reproduced trial-level outcomes \u2014 69% recanalization, 54% independence, 3% symptomatic hemorrhage \u2014 while modelled cost-effectiveness ratios of $26,875\u201371,333\/QALY exceeded regional thresholds. DISTALS achieved high reperfusion without symptomatic hemorrhage using a MeVO-dedicated stentretriever.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Routine MeVO thrombectomy is unjustified. Benefit concentrates in moderate-to-severe deficits, eloquent territory, salvageable tissue and technically accessible primary occlusions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11910-026-01515-0","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T07:42:48Z","timestamp":1789717368000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["MeVO: To Treat or Not To Treat? 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