{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:24:49Z","timestamp":1787757889850,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Endovascular thrombectomy (EVT) for distal and medium vessel occlusion stroke remains uncertain. We aimed to develop a medium and distal mechanical thrombectomy score integrating clinical need and procedural risk to guide patient selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This retrospective cohort analysis used an international distal and medium vessel occlusion stroke registry spanning the study period of 2017 to 2023. Patients with acute distal and medium vessel occlusion stroke who received medical management (MM) or EVT across 37 stroke centers were included, and those with baseline modified Rankin Scale score of \u22653 or those with missing covariable data were excluded. Multivariable logistic regression identified predictors of poor functional outcome (modified Rankin Scale score &gt;2 at 90 days) in the MM cohort and predictors of EVT failure\/complications in the EVT cohort. Predictors of poor outcome on MM were assigned positive weights (clinical need); predictors of EVT failure\/harm were assigned negative weights (procedural risk). The medium and distal mechanical thrombectomy score summed these weighted points. Interaction analysis assessed the heterogeneity of EVT effect by score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 1217 patients were identified, and 1007 were included (EVT: 822, MM: 185; median age 73 years; 41% female). Higher National Institutes of Health Stroke Scale score (+1 per point) and lack of intravenous thrombolysis (+7) predicted poor MM outcomes. In the EVT cohort, older age (\u22121 per 15 years above 25), absence of hypertension (\u22122), and absence of atrial fibrillation (\u22122) predicted failure\/complications. The medium and distal mechanical thrombectomy score (range \u22128 to 49) significantly modified EVT effect versus MM (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.048). In high-score patients (\u226515; n=293), EVT yielded a better 90-day modified Rankin Scale score than MM (median, 3 versus 4;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.009). Conversely, in low-score patients (&lt;15; n=710), EVT yielded a worse modified Rankin Scale score (median, 2 versus 1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.014).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The medium and distal mechanical thrombectomy score is a pragmatic tool that identifies patients with distal and medium vessel occlusion most likely to benefit from EVT while minimizing risk, supporting patient-centered decisions and future trial design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.054852","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T09:00:26Z","timestamp":1783501226000},"page":"2744-2753","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["MAD-MT Score: A Tool to Optimize Patient Selection for Mechanical Thrombectomy in Distal Vessel Occlusions"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2455-748X","authenticated-orcid":true,"given":"Huanwen","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Neurointerventional Surgery, Department of Neurosurgery, University of Maryland Medical Center, Baltimore (H.C., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7577-1887","authenticated-orcid":true,"given":"Dhairya A.","family":"Lakhani","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown (D.A.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5208-8425","authenticated-orcid":true,"given":"Hamza Adel","family":"Salim","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD (H.A.S., V.Y.)."},{"name":"Department of Neuroradiology, MD Anderson Medical Center, Houston, TX (H.A.S., O.H., M.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7823-3088","authenticated-orcid":true,"given":"Marco","family":"Colasurdo","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Oregon Health and Science University, Portland (M.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2450-4014","authenticated-orcid":true,"given":"Vivek","family":"Yedavalli","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Department of Radiology, Johns Hopkins Medical Center, Baltimore, MD (H.A.S., V.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4910-6090","authenticated-orcid":true,"given":"Basel","family":"Musmar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (B.M., K.E.N., P.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8668-7629","authenticated-orcid":true,"given":"Nimer","family":"Adeeb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge (N.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3601-9136","authenticated-orcid":true,"given":"Davide","family":"Simonato","sequence":"additional","affiliation":[{"name":"Nuffield Departments of Surgical Sciences and Clinical Neurosciences, Medical Sciences Division, University of Oxford, United Kingdom (D.S., Y.-L.L., M.F., A.A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1722-4188","authenticated-orcid":true,"given":"Yan-Lin","family":"Li","sequence":"additional","affiliation":[{"name":"Nuffield Departments of Surgical Sciences and Clinical Neurosciences, Medical Sciences Division, University of Oxford, United Kingdom (D.S., Y.-L.L., M.F., A.A.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8325-2382","authenticated-orcid":true,"given":"Muhammed Amir","family":"Essibayi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Laboratory, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (M.A.E., A. Baker, D.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6771-193X","authenticated-orcid":true,"given":"Orabi","family":"Hajjeh","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, MD Anderson Medical Center, Houston, TX (H.A.S., O.H., M.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3883-5623","authenticated-orcid":true,"given":"Nils","family":"Henninger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6017-3603","authenticated-orcid":true,"given":"Sri Hari","family":"Sundararajan","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery and Neuroradiology, Rutgers New Jersey Medical School, Newark (S.H.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9512-9461","authenticated-orcid":true,"given":"Anna Luisa","family":"K\u00fchn","sequence":"additional","affiliation":[{"name":"Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester (A.L.K., A.S.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3662-3886","authenticated-orcid":true,"given":"Jane","family":"Khalife","sequence":"additional","affiliation":[{"name":"Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, NJ (J.K., J.E.S., H.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5629-3023","authenticated-orcid":true,"given":"Sherief","family":"Ghozy","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC Program) (S.G.), University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6838-9532","authenticated-orcid":true,"given":"Fulvio","family":"Zaccagna","sequence":"additional","affiliation":[{"name":"Oxford Centre for Clinical Magnetic Resonance Research (F.Z., J.T.G., A.A.D.), University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7223-4031","authenticated-orcid":true,"given":"James T.","family":"Grist","sequence":"additional","affiliation":[{"name":"Oxford Centre for Clinical Magnetic Resonance Research (F.Z., J.T.G., A.A.D.), University of Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1316-0383","authenticated-orcid":true,"given":"Luca","family":"Scarcia","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Henri Mondor Hospital, Creteil, France (L.S., E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4249-0402","authenticated-orcid":true,"given":"Leonard L.L.","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (L.L.L.Y., B.Y.Q.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1824-9077","authenticated-orcid":true,"given":"Benjamin Y.Q.","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (L.L.L.Y., B.Y.Q.T.)."},{"name":"Division of Neurology, Department of Medicine, National University Hospital, Singapore (B.Y.Q.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-3484","authenticated-orcid":true,"given":"Robert 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