Endovascular thrombectomy for stroke due to medium vessel occlusion: a meta-analysis of randomized controlled trials.

BACKGROUND: Medium vessel occlusion (MeVO) strokes are a unique subgroup with potentially debilitating results, with limited literature on treatment options. This meta-analysis assesses the efficacy of endovascular thrombectomy (EVT) in MeVO stroke. METHODS: Science Direct, PubMed, and The Cochrane Library were searched for randomized controlled trials from 2010 to 2025. All studies included MeVO stroke patients aged ≥18 years, NIHSS ≥5, and those undergoing EVT. Endpoints included modified Rankin Scale (mRS) score (0-1), symptomatic intracranial hemorrhage (SICH), and mortality. ROB2 was used to assess the quality of studies, and risk ratios (RRs) were calculated. The protocol was registered on PROSPERO. RESULTS: Only four trials were included from the original 5912 articles retrieved. Results showed mRS score improvement with EVT [RR 1.09; 95% confidence interval (CI) 0.84-1.42; P = 0.54], while showing a minor increase in SICH with EVT (RR 1.54; 95% CI 0.48-5.00; P = 0.47). No difference was observed in mortality between the two groups (RR 1.00; 95% CI 0.55-1.79; P = 0.99). None of the results were statistically significant. CONCLUSION: Endovascular therapy showed no significant benefit in MeVO stroke; however, existing data are inconclusive and require further research.