Thrombectomy for Acute Stroke Due to Medium Vessel Occlusion Across Perfusion Mismatch Profiles: A Post Hoc - Scorecard - MDSpire
Coming Soon: Introducing MDSpire News. Learn more
Conexiant’s news site is now MDSpire News. Learn more

Thrombectomy for Acute Stroke From Medium Vessel Occlusion Across Perfusion Mismatch Patterns: A Post Hoc Analysis

  • By

  • Umberto Pensato

  • Gunjan Jindal

  • William Diprose

  • Aravind Ganesh

  • Pattarawut Charatpangoon

  • Ethan MacDonald

  • Alexander Stebner

  • Salome Bosshart

  • Dar Dowlatshahi

  • David Volders

  • James Kennedy

  • Markus Möhlenbruch

  • Brian H. Buck

  • Shahid Nimjee

  • Thomas Booth

  • Mouhammad Jumaa

  • Jai J. Shankar

  • Franziska Dorn

  • Andrew M. Demchuk

  • Mayank Goyal

  • Michael D. Hill

  • Johanna M. Ospel

  • ESCAPE-MEVO Investigators

  • Jennifer Mandzia

  • Sachin Pandey

  • Jesse Klostranec

  • Lissa Peeling

  • Joanna Schaafsma

  • Timo Krings

  • Atif Zafar

  • Ravinder-Jeet Singh

  • Demetrios Sahlas

  • Thalia Field

  • Richard Swartz

  • Pual (Inder) Singh

  • Koji Ebersole

  • Negar Asdashi

  • Dileep Yavagal

  • Reade De Leacy

  • George Lopez

  • Babak Jahromi

  • Ronald Budzik

  • Seon-Kyu Lee

  • Eric Sauvageau

  • Adewumi Amole

  • Maxim Mokin

  • Mchael Levitt

  • Jason Tarpley

  • Albert Yoo

  • Michael Chen

  • Thanhn Nguyen

  • Santiago Ortega-Gutierrez

  • Adnan Siddiqui

  • Fabio Settecase

  • Thien Huynh

  • Tufail Patankar

  • Levansri Makalanda

  • Paul Burns

  • Changez Jadun

  • Aubrey Smith

  • Kyriakos Lobotesis

  • Rob Crossley

  • Robert Lenthall

  • Thant Hlaing

  • Ayokunle Ogungbemi

  • Liqun Zhang

  • Richard Marigold

  • Yogish Joshi

  • Richard Perry

  • Christian Hametner

  • Sven Poli

  • Joerg Berrouschot

  • Christian Taschner

  • Arno Reich

  • Hauke Scheider

  • Sandor Nardai

  • Gabor Lenzser

  • October 13, 2026

Share

Clinical Scorecard: Thrombectomy for Acute Stroke From Medium Vessel Occlusion Across Perfusion Mismatch Patterns: A Post Hoc Analysis

At a Glance

CategoryDetail
ConditionAcute ischemic stroke attributable to medium vessel occlusion (MeVO).
Key MechanismsThe analysis assessed whether perfusion mismatch profiles were associated with functional outcomes and whether they modified the effect of endovascular thrombectomy (EVT).
Target PopulationAdults enrolled in ESCAPE-MeVO with interpretable baseline perfusion imaging and an available 90-day modified Rankin Scale score.
Care SettingMulticenter randomized clinical trial enrolling adults within 12 hours of symptom onset or last known well; trial eligibility required salvageable brain tissue on baseline imaging.

Key Highlights

  • This post hoc analysis used data from the ESCAPE-MeVO randomized clinical trial comparing EVT plus medical therapy with medical therapy alone.
  • Eligible occlusions involved specified M2 or M3 middle cerebral, A2 or A3 anterior cerebral, or P2 or P3 posterior cerebral artery segments.
  • Perfusion mismatch volume was calculated as the difference between Tmax greater than 6 seconds volume and rCBF 30% or lower volume; mismatch ratio was the Tmax greater than 6 seconds volume divided by the rCBF 30% or lower volume.
  • The supplied excerpt describes the study rationale and methods but does not provide the analysis results.

Guideline-Based Recommendations

Diagnosis

  • For trial eligibility, MeVO was defined on CT angiography or MRI angiography as occlusion of specified M2/M3, A2/A3, or P2/P3 segments.
  • Trial eligibility excluded patients without salvageable brain tissue, including those with extensive established infarction, absent collaterals, or no visually determined core-penumbra mismatch.

Management

  • The trial compared EVT added to medical therapy with medical therapy alone; the excerpt does not report comparative outcome results or a treatment recommendation.
  • Intravenous alteplase or tenecteplase was given before thrombectomy when guideline-based indications were fulfilled.
  • A Solitaire X family device was used for the initial EVT attempt; operators selected tools and techniques for subsequent attempts.

Monitoring & Follow-up

  • Successful reperfusion was defined as MeVO-eTICI score of 2b or higher, corresponding to reperfusion of 50%-100% of the involved territory.
  • The excerpt describes manual assessment of 24-hour infarct volume using noncontrast CT or diffusion-weighted MRI.

Risks

  • The background notes that EVT procedures for MeVO may be technically more difficult than for large vessel occlusion.
  • The authors cite greater response to intravenous thrombolysis and smaller amounts of salvageable eloquent brain tissue as possible explanations for differing EVT benefit between MeVO and large vessel occlusion.
  • The supplied excerpt does not report adverse-event results from this post hoc analysis.

Patient & Prescribing Data

Adults with acute ischemic stroke attributable to MeVO, presenting within 12 hours, with NIHSS score of at least 6 or score 3-5 with a disabling deficit, and trial imaging eligibility for salvageable tissue; this analysis included participants with interpretable baseline perfusion imaging and available 90-day mRS.

ESCAPE-MeVO randomized participants to EVT plus medical therapy or medical therapy alone. Intravenous alteplase or tenecteplase was administered before thrombectomy when guideline-based indications were met. The excerpt provides no treatment-effect estimates.

Clinical Best Practices

  • The trial identified MeVO using noninvasive CT angiography or MRI angiography.
  • Trial eligibility assessed established infarction, collateral status, and visually determined core-penumbra mismatch.
  • The study defined ischemic core as rCBF 30% or lower and critically hypoperfused tissue as Tmax greater than 6 seconds.
  • The supplied excerpt does not include results supporting a clinical recommendation.

Related Resources & Content

Original Source(s)

Thrombectomy for Acute Stroke Due to Medium Vessel Occlusion Across Perfusion Mismatch Profiles: A Post Hoc

  • by Umberto Pensato, Gunjan Jindal, William Diprose, Aravind Ganesh, Pattarawut Charatpangoon, Ethan MacDonald, Alexander Stebner, Salome Bosshart, Dar Dowlatshahi, David Volders, James Kennedy, Markus Möhlenbruch, Brian H. Buck, Shahid Nimjee, Thomas Booth, Mouhammad Jumaa, Jai J. Shankar, Franziska Dorn, Andrew M. Demchuk, Mayank Goyal, Michael D. Hill, Johanna M. Ospel, ESCAPE-MEVO Investigators, Jennifer Mandzia, Sachin Pandey, Jesse Klostranec, Lissa Peeling, Joanna Schaafsma, Timo Krings, Atif Zafar, Ravinder-Jeet Singh, Demetrios Sahlas, Thalia Field, Richard Swartz, Pual (Inder) Singh, Koji Ebersole, Negar Asdashi, Dileep Yavagal, Reade De Leacy, George Lopez, Babak Jahromi, Ronald Budzik, Seon-Kyu Lee, Eric Sauvageau, Adewumi Amole, Maxim Mokin, Mchael Levitt, Jason Tarpley, Albert Yoo, Michael Chen, Thanhn Nguyen, Santiago Ortega-Gutierrez, Adnan Siddiqui, Fabio Settecase, Thien Huynh, Tufail Patankar, Levansri Makalanda, Paul Burns, Changez Jadun, Aubrey Smith, Kyriakos Lobotesis, Rob Crossley, Robert Lenthall, Thant Hlaing, Ayokunle Ogungbemi, Liqun Zhang, Richard Marigold, Yogish Joshi, Richard Perry, Christian Hametner, Sven Poli, Joerg Berrouschot, Christian Taschner, Arno Reich, Hauke Scheider, Sandor Nardai, Gabor Lenzser

  • October 13, 2026

Related Content

Why We Need Biomarkers in Psychiatry

Consensus statement outlines how standardized, validated biological tests could move psychiatric diagnosis and treatment beyond symptom-based classification

  • September 30, 2026

  • 2 min
Daniela Lozano, M.D., Joins Baptist Health Kenneth C. Griffin Neuroscience Institute as a Headache Neurologist

Board-certified and fellowship-trained neurologist Daniela Lozano, M.D., has joined Baptist Health Kenneth C. Griffin Neuroscience Institute.

  • by

  • October 13, 2026

  • 2 min
The association between MGMT expression and outcome in H3 G34-mutant diffuse hemispheric glioma is robust to adjustment for pre-analytic and technical variables