Clot Retrieval and Medication Show Equal Effectiveness in Stroke Recovery

Recent research presented at the American Stroke Association's International Stroke Conference 2025 reveals that both mechanical clot retrieval and clot-busting medication are equally effective in reducing disability for patients experiencing a specific type of ischemic stroke.

Ischemic strokes, which occur due to blockages in the brain's arteries, account for a significant portion of stroke cases. The study focuses on medium distal vessel occlusion (MDVO), where clots obstruct medium- or small-sized arteries above the brain's base. According to the lead researcher, Marios Psychogios, M.D., from the University Hospital Basel in Switzerland, the prevalence of ischemic strokes is increasing, particularly among aging populations. This growing concern emphasizes the need for effective treatment options as many patients do not regain functional independence following such strokes.

Endovascular therapy, which involves using catheters to remove clots and restore blood flow, has been recommended for patients with large artery blockages. However, its benefits for those with medium vessel blockages have remained uncertain.

The DISTAL trial, initiated in 2021, aimed to determine whether adding endovascular therapy to standard medical treatment could yield better outcomes than medication alone. The study involved 543 adult patients with confirmed medium distal vessel blockages, who were randomly assigned to receive either standard treatment or a combination of standard treatment plus endovascular therapy.

Findings from the trial indicated no significant difference in disability levels between the two treatment groups after 90 days. Mortality rates were also comparable, with 15.5% of patients receiving endovascular therapy and 14% of those on standard medical care alone succumbing to the condition. Instances of severe symptomatic brain bleeds were recorded at 5.9% for the endovascular treatment group compared to 2.6% for the standard treatment group.

According to co-principal investigator Urs Fischer, M.D., M.Sc., the current techniques for endovascular therapy may not offer additional benefits for all patients with medium distal vessel occlusions. While it remains a safe option, it may warrant reevaluation as a standard treatment method for this specific condition.

The study's outcomes were unexpected and revealed a more severe impact on participants than previously anticipated. Researchers are now analyzing whether certain patient characteristics could help identify individuals who might benefit more from endovascular therapy.

It is essential to note that the majority of study participants were white, limiting the generalizability of the results to broader populations. The study's design aimed to reflect real-world applications of mechanical clot removal but may have restricted the detection of positive outcomes that could have emerged from a more selective patient group.

Despite the study's discouraging findings, researchers view it as a crucial reminder to persist in exploring effective treatment strategies for patients suffering from medium or distal vessel occlusions. The severity of observed outcomes indicates a pressing need for evidence-based interventions in this area.

The DISTAL trial involved multiple centers across Switzerland, Germany, Belgium, Spain, Portugal, Italy, the Netherlands, Sweden, Israel, Finland, and the United Kingdom, enrolling patients from December 2021 to July 2024.

Overall, this significant research contributes to the ongoing discussion regarding stroke treatment and highlights the necessity for continued investigation into effective therapies for medium distal vessel occlusions.