ArticleStroke2020
Clinical Course of Acute Ischemic Stroke Due to Medium Vessel Occlusion With and Without Intravenous Alteplase Treatment.
Article in Stroke, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 82 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Phase III, Randomized, Multicenter, Investigational, Open Label Clinical Trial That Will Examine Whether Treatment With Endovascular Thrombectomy is Superior to Standard Medical Therapy Alone in Patients Who Suffer a Distal Medium Vessel Occlusion Ischemic Strokes.
Efficacy and Safety of Tirofiban in Patients With Acute Branch Atheromatous Disease (BAD)- Related Stroke (BRANT)
Intra-arterial Tenecteplase for Acute Medium Vessel Occlusion Stroke: the ANGEL-MeVO-TNK Randomized Clinical Trial
Who cites it
82 citing papers in PubMed, 5 syntheses or guidelines pooled it, 156 citations in OpenAlex.
- Mechanical Thrombectomy Versus Best Medical Treatment for Patients with Acute Ischemic Stroke and Primary Distal Medium Vessel Occlusion: a Systemic Review and Meta-Analysis.Clinical neuroradiology · 2026Pooled it
- Thrombectomy for Distal Medium Vessel Occlusion: A Meta-Analysis of Randomized Controlled Trials.Journal of the American Heart Association · 2025Pooled it
- Early antiplatelet therapy after intravenous thrombolysis for acute ischemic stroke: a systematic review and meta-analysis.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Pooled it
- Angiographic Systems for Classifying Distal Arterial Occlusions.Cerebrovascular diseases (Basel, Switzerland) · 2023Pooled it
- Comparative efficacy of Honghua class injections for treating acute ischemic stroke: A Bayesian network meta-analysis of randomized controlled trials.Frontiers in pharmacology · 2022Pooled it
- Endovascular treatment to improve outcomes for medium vessel occlusions: The ESCAPE-MeVO trial.International journal of stroke : official journal of the International Stroke Society · 2024Trial
- MeVO: To Treat or Not To Treat? Review of the Latest Evidence.Current neurology and neuroscience reports · 2026Review
- Intra-Arterial Thrombolytic vs. Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Acute Ischemic Stroke: A Preliminary Multinational Multicenter Propensity Score-Matched Study.Clinical neuroradiology · 2026Observational
- Navigating the Complexity and Heterogeneity of Thrombectomy Decision-Making for Medium-Vessel Occlusion Stroke: Where Do We Go From Here?Stroke (Hoboken, N.J.) · 2026Review
- Endovascular treatment versus standard medical management in primary M3 or M4 occlusion stroke in clinical practice: the oriental-MeVO registry.BMC neurology · 2026Article
- Intravenous Thrombolysis in Distal Medium Middle Cerebral Artery Occlusion Patients with Unsuccessful Mechanical Reperfusion.Clinical neuroradiology · 2026Article
- Distal Vessel Occlusion Stroke: Lessons from Recent Randomized Trials and Implications for Future Study Design.Annals of Indian Academy of Neurology · 2026Article
- The effect of occlusion location and technique in mechanical thrombectomy for minor stroke.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2026Article
- Effectiveness and safety of endovascular therapy compared to intravenous thrombolysis in acute ischaemic stroke due to medium-vessel occlusions: a real-world multicentre study from the Italian SITS registry.European stroke journal · 2026Article
- Endovascular Therapy Versus Nonendovascular Therapy for Acute Ischemic Stroke With Distal Medium Vessel Occlusion: A Systematic Review and Meta-Analysis.Stroke (Hoboken, N.J.) · 2026Article
- Successful reperfusion for better outcomes in medium vessel occlusion: Penumbral salvage versus infarct volume reduction.European stroke journal · 2026Observational
- Tenecteplase versus standard medical treatment for minor stroke due to anterior-circulation medium-vessel occlusion: a multicenter observational study.Frontiers in neuroscience · 2026Article
- Clinical outcomes of patients with unsuccessful mechanical thrombectomy versus best medical management of medium vessel occlusion stroke in the middle cerebral artery territory.Journal of neurointerventional surgery · 2025Article
- Real-World outcomes of thrombectomy for distal medium vessel occlusions in the middle East and North Africa region: A multicenter registry analysis.Neuroradiology · 2025Observational
- Article
22 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
18 authors at 11 institutions in 6 countries.
Funding
Abstract
background and purposeAvailable data on the clinical course of patients with acute ischemic stroke due to medium vessel occlusion (MeVO) are mostly limited to those with M2 segment occlusions. Outcomes are generally better compared with more proximal occlusions, but many patients will still suffer from severe morbidity. We aimed to determine the clinical course of acute ischemic stroke due to MeVO with and without intravenous alteplase treatment.
methodsPatients with MeVO (M2/M3/A2/A3/P2/P3 occlusion) from the INTERRSeCT (The Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) and PRoveIT (Precise and Rapid Assessment of Collaterals Using Multi-Phase CTA in the Triage of Patients With Acute Ischemic Stroke for IA Therapy) studies were included. Baseline characteristics and clinical outcomes were summarized using descriptive statistics. The primary outcome was a modified Rankin Scale score of 0 to 1 at 90 days, describing excellent functional outcome. Secondary outcomes were the common odds ratio for a 1-point shift across the modified Rankin Scale and functional independence, defined as modified Rankin Scale score of 0 to 2. We compared outcomes between patients with versus without intravenous alteplase treatment and between patients who did and did not show recanalization on follow-up computed tomography angiography. Logistic regression was used to provide adjusted effect-size estimates.
resultsAmong 258 patients with MeVO, the median baseline National Institutes of Health Stroke Scale score was 7 (interquartile range: 5-12). A total of 72.1% (186/258) patients were treated with intravenous alteplase and in 41.8% (84/201), recanalization of the occlusion (revised arterial occlusive lesion score 2b/3) was seen on follow-up computed tomography angiography. Excellent functional outcome was achieved by 50.0% (129/258), and 67.4% (174/258) patients gained functional independence, while 8.9% (23/258) patients died within 90 days. Recanalization was observed in 21.4% (9/42) patients who were not treated with alteplase and 47.2% (75/159) patients treated with alteplase (
conclusionsOne of every 2 patients with MeVO did not achieve excellent clinical outcome at 90 days with best medical management. Early recanalization was strongly associated with excellent outcome but occurred in <50% of patients despite intravenous alteplase treatment.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.