Thrombectomy for Medium or Distal Vessel Occlusion

About this episode

Medium or distal vessel occlusions account for up to a third of ischaemic stroke, but recent randomised trials have raised important questions about the role of thrombectomy in these patients. In the latest Voice of Stroke podcast episode, we explore new evidence searching for the "green flags" that could help identify patients with medium or distal vessel occlusion who may benefit from thrombectomy. This episode discusses: • The ORIENTAL-MeVO trial and thrombectomy in patients with moderate-to-severe neurological deficits • Whether baseline imaging and collateral status may help identify differences in treatment response • Evidence from DISTAL examining whether thrombectomy can preserve threatened brain tissue Featuring discussion of recent research published in: · New England Journal of Medicine · Radiology · JAMA Neurology Written by: Umberto Pensato, Voice of Stroke Podcast Editor, and Linxin Li, Voice of Stroke Editor-in-Chief. Read the full transcript. References 1. Liu J, Cui T, Wen J, et al. Endovascular Treatment of Medium-Vessel-Occlusion Strokes. N Engl J Med. 2026;394:1894-1904. 2. Ospel JM, Diprose WK, Uchida K, et al. Reperfusion Therapy in ESCAPE-MeVO Trial Participants: Imaging Characteristics and Clinical Outcomes. Radiology. 2026;319:e251769. 3. Anastasiou A, Corbaz H, Christodoulou E, et al. Mechanical Thrombectomy and Final Infarct Volume in Medium or Distal Vessel Occlusion Stroke: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Neurol. 2026;83:537-543. 4. Goyal M, Ospel JM, Ganesh A, et al. Endovascular Treatment of Stroke Due to Medium-Vessel Occlusion. N Engl J Med. 2025;392:1385-1395. 5. Psychogios M, Brehm A, Ribo M, et al. Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels. N Engl J Med. 2025;392:1374-1384. 6. Clarençon F, Bala F, Baptiste A, et al. Mechanical Thrombectomy in Ischemic Stroke With a Medium or Distal Arterial Occlusion: The DISCOUNT Randomized Clinical Trial. JAMA. 2026;336:755–764. 7. Prabhakaran S, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2026;57:e316–e436.