ESCAPE-MeVO Trial Reveals No Benefit of Endovascular Thrombectomy for Medium-Vessel Occlusions

A groundbreaking study presented at the 2025 International Stroke Conference (ISC) in Los Angeles has found that adding endovascular thrombectomy (EVT) to standard medical care does not improve outcomes for patients with acute ischemic stroke caused by medium-vessel occlusions (MeVOs) compared to medical care alone.

Study Details and Methodology

The ESCAPE-MeVO trial, conducted on 530 patients with MeVOs, aimed to evaluate the efficacy of EVT in conjunction with best medical care. Participants were randomly assigned to receive either best medical care or EVT plus best medical care and were followed up at 90 days. Study inclusion criteria included a National Institutes of Health Stroke Scale (NIHSS) score of at least 5 or between 3-5 with disabling deficits, and a high likelihood of salvageable tissue on imaging.

Findings from the ESCAPE-MeVO Trial

The primary endpoint, defined as a modified Rankin Score (mRS) of 0-1 at 90 days, showed no significant difference between the two groups. The unadjusted risk ratio was 0.97 (95% CI, 0.79-1.18), with adjusted results showing a risk ratio of 0.95 (95% CI, 0.79-1.15). Similar findings were observed for secondary endpoints, such as mRS scores of 0-2 at 90 days (unadjusted RR, 0.92; adjusted RR, 0.92).

Mortality and Safety Considerations

The study also revealed higher mortality rates in the EVT group (13.3%) compared to the medical care group (8.4%), though the adjusted hazard ratio of 1.82 was not statistically significant (95% CI, 1.06-3.12). Additionally, the EVT group had higher rates of serious adverse events, including pneumonia, recurrent stroke, and stroke progression. However, it also had a lower incidence of atrial fibrillation.

Implications for Future Research and Treatment

The trial’s findings challenge existing treatment paradigms for MeVOs. The authors highlighted several limitations and future research areas, including whether MeVOs behave more like end arteries that require immediate intervention. They also questioned whether the mRS is an appropriate outcome measure for patients with mild deficits.

Workflow improvements and quality enhancements in recanalization processes are essential. The debate around the community’s equipoise on treatment approaches will likely be a central focus in future studies.

While the ESCAPE-MeVO trial did not show a benefit of EVT for MeVOs, it provides critical insights that will shape ongoing research and clinical practices.

Learn more about the ISC 2025 conference and other developments in stroke treatment.

Conclusion

The ESCAPE-MeVO trial is a landmark study that highlights the need for further research in stroke treatment. It underscores the complexity of treating medium-vessel occlusions and the importance of continued clinical trials to refine treatment strategies.

As healthcare professionals and patients await further developments, the insights from this study will play a pivotal role in shaping future approaches to managing acute ischemic stroke.

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