The aim of this study is to compare the efficacy and safety of endovascular thrombectomy (EVT) vs intravenous thrombolysis (IVT) in patients with medium vessel occlusion (MeVO) strokes.

Medium vessel occlusion (MeVO) affects 25-40% of patients with acute ischemic stroke. Historically, individuals with MeVO have been excluded from major endovascular thrombectomy (EVT) trials, maintaining intravenous thrombolysis (IVT) as the standard acute treatment. There is limited evidence directly comparing the efficacy and safety of EVT compared to IVT in MeVO cases.

Following recommended guidelines, a systematic review and study-level meta-analysis was conducted. English-language studies comparing EVT to IVT in patients with MeVO stroke from inception to September 2024 were identified through electronic databases. Odds ratios (ORs) with their corresponding 95% confidence intervals (CIs) were calculated using a random-effects model.

Our inclusion criteria were met by five observational studies, totalling 2,208 patients. Among them, 1,330 received EVT, while 878 received IVT alone. Prior to EVT, bridging IVT was administered to 60.5% of patients. Our meta-analysis revealed no significant difference between the two groups in terms of excellent functional outcomes (OR=0.79, 95% CI [0.62-1.02], p=0.07) and good functional outcomes (OR=0.95, 95% CI [0.74-1.22], p=0.69). Similarly, there were no notable variations in the rates of symptomatic intracranial hemorrhage (OR=1.21, 95% CI [0.58-2.55], p=0.61) and 90-day mortality (OR=1.14, 95% CI [0.75-1.74], p=0.55).

This meta-analysis showed similar efficacy and safety outcomes between EVT and IVT in patients with MeVO stroke. Randomized controlled trials are needed to determine the most suitable acute treatment for this specific patient cohort.