{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:54:27Z","timestamp":1790927667682,"version":"4.1.0"},"reference-count":0,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cerebrovasc Dis"],"abstract":"<jats:p>Background: Evidence on endovascular thrombectomy (EVT) for distal medium vessel occlusion (DMVO) stroke remains insufficient, and its efficacy across severity levels is unclear. Methods: Systematic search of databases for RCTs and observational studies comparing EVT versus best medical treatment (BMT) in DMVO patients. Patients were stratified by NIHSS (&lt;6, \u22656, unreported) and occlusion site (MCA, PCA, ACA). Primary outcome: 90-day mRS 0\u20131. Secondary outcomes: mRS 0\u20132, mortality, and symptomatic intracranial hemorrhage (sICH). Results: 3 RCTs (n=1,233) and 39 observational studies (n=11,148) were included. RCTs showed no significant difference between EVT+BMT and BMT alone in mRS 0\u20131 (RR 0.95, 95% CI 0.82\u20131.10), mRS 0\u20132 (RR 0.92, 95% CI 0.80\u20131.06), or mortality (OR 1.23, 95% CI 0.76\u20131.99), but EVT significantly increased sICH risk (OR 2.38, 95% CI 1.35\u20134.20, p=0.003). Observational studies similarly found no differences in functional outcomes or mortality, with elevated sICH in the EVT group (OR 1.69, 95% CI 1.14\u20132.50, p=0.008). Subgroup analyses suggested a potential gradient effect: in NIHSS \u22656 patients, EVT showed no significant benefit in primary analysis, but a sensitivity analysis excluding heterogeneous studies yielded a potential signal (mRS 0\u20131: RR 1.18, 95% CI 1.01\u20131.37, p=0.04). Conversely, in NIHSS &lt;6 patients, BMT alone appeared non-inferior (RR 0.91, 95% CI 0.82\u20131.00, p=0.05). Conclusion: EVT does not improve functional outcomes in overall DMVO but increases sICH risk. Exploratory analyses suggest EVT may benefit more severe (NIHSS \u22656) or proximal occlusion patients, whereas BMT alone may suffice for milder cases. These findings are hypothesis-generating and require RCT validation.<\/jats:p>","DOI":"10.1159\/ced\/accag029","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:50:38Z","timestamp":1790164238000},"source":"Crossref","is-referenced-by-count":0,"title":["Is Endovascular Thrombectomy Effective for Distal Medium Vessel Occlusion Stroke? A Meta-Analysis of Randomized Controlled Trials and Observational Studies"],"prefix":"10.1159","author":[{"given":"Jian","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuli","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"jiaying","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"junlong","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MingFei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"zhanying","family":"Ju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,9,29]]},"container-title":["Cerebrovascular Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/ced\/accag029","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:17:38Z","timestamp":1790925458000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/ced\/accag029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1159\/ced\/accag029","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.33993871","asserted-by":"subject"}]},"ISSN":["1015-9770","1421-9786"],"issn-type":[{"value":"1015-9770","type":"print"},{"value":"1421-9786","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]}}}