{
  "abstract": "Importance: Recent trials have not demonstrated a benefit of endovascular thrombectomy (EVT) over medical therapy in acute stroke due to medium vessel occlusion (MeVO). However, it remains uncertain whether selected patients with favorable perfusion may benefit from EVT.\n\nObjective: To investigate the association between perfusion mismatch profiles and functional outcomes in MeVO stroke and to determine whether these profiles modify the effect of EVT.\n\nDesign, Setting, and Participants: This study was a post hoc analysis of ESCAPE-MeVO (Endovascular Treatment to Improve Outcomes for Medium Vessel Occlusion), a multicenter randomized clinical trial conducted in North America, Europe, and the United Kingdom between April 2022 and June 2024, with a 90-day follow-up. Trial participants included patients with acute MeVO stroke presenting within 12 hours from last known well and evidence of salvageable brain tissue. This analysis included only patients with interpretable baseline perfusion imaging. Data were analyzed from March to July 2026.\n\nInterventions: Randomization to EVT plus usual care vs usual care alone.\n\nMain outcomes and measures: The primary outcome was the 90-day ordinal modified Rankin Scale (mRS) score. Secondary outcomes included 24-hour follow-up infarct volume and 90-day mRS score of 0 to 1 and 0 to 2. Perfusion mismatch ratio and volume were defined as the ratio and difference between the critically hypoperfused area and the ischemic core, with volume thresholds defined by site-specific postprocessing software.\n\nResults: Of 530 enrolled patients, 309 (58.3%) had available baseline perfusion imaging and were included in this study (EVT: n = 146; usual care: n = 163). Patient median (IQR) age was 73 (63-82) years, and 141 (45.6%) were women. Median (IQR) perfusion mismatch volume was 37.2 (22.1-57.2) mL, and the median (IQR) mismatch ratio was 6.1 (2.8-10.0). Ordinal 90-day mRS score was not associated with perfusion mismatch volume (adjusted odds ratio [AOR], 1.03 [95% CI, 0.99-1.07] per 10-mL increase) or perfusion mismatch ratio (AOR, 1.03 [95% CI, 0.97-1.09] per 1-unit increase). There was no modification of EVT effect by perfusion mismatch volume or ratio on ordinal 90-day mRS. Results were consistent across secondary outcomes and subgroups.\n\nConclusions and Relevance: In this exploratory post hoc analysis of acute MeVO stroke, perfusion mismatch profiles were not associated with functional outcomes and did not modify the effect of EVT. These findings suggest that perfusion imaging profiles based on currently used thresholds and cutoffs did not identify patients likely to benefit from EVT in the ESCAPE-MeVO trial.\n\nTrial Registration: ClinicalTrials.gov Identifier: NCT05151172",
  "abstract_shown": true,
  "affiliations": [
    "Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy",
    "Department of Neurology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy",
    "Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada",
    "Faculty of Medical and Health Sciences, University of Auckland–Grafton Campus, Auckland, New Zealand",
    "Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada",
    "Department of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada",
    "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
    "Department of Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada",
    "Radcliffe Department of Medicine, Oxford, United Kingdom",
    "Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany",
    "Department of Medicine (Neurology), University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada",
    "Ohio State University Wexner Medical Center, Columbus",
    "Department of Neuroradiology, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom",
    "School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom",
    "Department of Neurology, University of Toledo, Toledo, Ohio",
    "Promedica Neuroscience Institute, Toledo, Ohio",
    "Department of Radiology, University of Manitoba Faculty of Medicine, Winnipeg, Manitoba, Canada",
    "Department of Neuroradiology, University Hospital Bonn, Bonn, Germany",
    "for the ESCAPE-MEVO Investigators"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 78,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Umberto Pensato"
    },
    {
      "affs": [
        2
      ],
      "name": "Gunjan Jindal"
    },
    {
      "affs": [
        3
      ],
      "name": "William Diprose"
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    {
      "affs": [
        4
      ],
      "name": "Aravind Ganesh"
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    {
      "affs": [
        4
      ],
      "name": "Pattarawut Charatpangoon"
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    {
      "affs": [
        4
      ],
      "name": "Ethan MacDonald"
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    {
      "affs": [
        2
      ],
      "name": "Alexander Stebner"
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    {
      "affs": [
        2
      ],
      "name": "Salome Bosshart"
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    {
      "affs": [
        5,
        6
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      "name": "Dar Dowlatshahi"
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      "affs": [
        7
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      "name": "David Volders"
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    {
      "affs": [
        8
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      "name": "James Kennedy"
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    {
      "affs": [
        9
      ],
      "name": "Markus Möhlenbruch"
    },
    {
      "affs": [
        10
      ],
      "name": "Brian H. Buck"
    },
    {
      "affs": [
        11
      ],
      "name": "Shahid Nimjee"
    },
    {
      "affs": [
        12,
        13
      ],
      "name": "Thomas Booth"
    },
    {
      "affs": [
        14,
        15
      ],
      "name": "Mouhammad Jumaa"
    },
    {
      "affs": [
        16
      ],
      "name": "Jai J. Shankar"
    },
    {
      "affs": [
        17
      ],
      "name": "Franziska Dorn"
    },
    {
      "affs": [
        2,
        4
      ],
      "name": "Andrew M. Demchuk"
    },
    {
      "affs": [
        2,
        4
      ],
      "name": "Mayank Goyal"
    },
    {
      "affs": [
        2,
        4
      ],
      "name": "Michael D. Hill"
    },
    {
      "affs": [
        2,
        4
      ],
      "name": "Johanna M. Ospel"
    },
    {
      "name": "ESCAPE-MEVO Investigators"
    },
    {
      "affs": [
        18
      ],
      "name": "Jennifer Mandzia"
    },
    {
      "affs": [
        18
      ],
      "name": "Sachin Pandey"
    },
    {
      "affs": [
        18
      ],
      "name": "Jesse Klostranec"
    },
    {
      "affs": [
        18
      ],
      "name": "Lissa Peeling"
    },
    {
      "affs": [
        18
      ],
      "name": "Joanna Schaafsma"
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    {
      "affs": [
        18
      ],
      "name": "Timo Krings"
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      "affs": [
        18
      ],
      "name": "Atif Zafar"
    },
    {
      "affs": [
        18
      ],
      "name": "Ravinder-Jeet Singh"
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    {
      "affs": [
        18
      ],
      "name": "Demetrios Sahlas"
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    {
      "affs": [
        18
      ],
      "name": "Thalia Field"
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    {
      "affs": [
        18
      ],
      "name": "Richard Swartz"
    },
    {
      "affs": [
        18
      ],
      "name": "Pual (Inder) Singh"
    },
    {
      "affs": [
        18
      ],
      "name": "Koji Ebersole"
    },
    {
      "affs": [
        18
      ],
      "name": "Shahid Nimjee"
    },
    {
      "affs": [
        18
      ],
      "name": "Negar Asdashi"
    },
    {
      "affs": [
        18
      ],
      "name": "Dileep Yavagal"
    },
    {
      "affs": [
        18
      ],
      "name": "Reade De Leacy"
    },
    {
      "affs": [
        18
      ],
      "name": "George Lopez"
    },
    {
      "affs": [
        18
      ],
      "name": "Babak Jahromi"
    },
    {
      "affs": [
        18
      ],
      "name": "Ronald Budzik"
    },
    {
      "affs": [
        18
      ],
      "name": "Seon-Kyu Lee"
    },
    {
      "affs": [
        18
      ],
      "name": "Eric Sauvageau"
    },
    {
      "affs": [
        18
      ],
      "name": "Adewumi Amole"
    },
    {
      "affs": [
        18
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      "name": "Maxim Mokin"
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    {
      "affs": [
        18
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      "name": "Mchael Levitt"
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    {
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      "name": "Jason Tarpley"
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        18
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      "name": "Albert Yoo"
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      "affs": [
        18
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      "name": "Michael Chen"
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    {
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        18
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      "name": "Thanhn Nguyen"
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        18
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      "name": "Santiago Ortega-Gutierrez"
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    {
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      "name": "Adnan Siddiqui"
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      "name": "Fabio Settecase"
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      "name": "Thien Huynh"
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      "name": "Tufail Patankar"
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        18
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      "name": "Levansri Makalanda"
    },
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        18
      ],
      "name": "Paul Burns"
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    {
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        18
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      "name": "Changez Jadun"
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  ],
  "bibtex": "https://research.draconitic.com/paper/fz51br1x7dghk.bib",
  "cited_by": 0,
  "doi": "10.1001/jamanetworkopen.2026.38823",
  "fulltext_url": null,
  "id": "fz51br1x7dghk",
  "issns": [
    "2574-3805"
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  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Acute Ischemic Stroke Management"
    ]
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  "openalex": "W7221616417",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-13",
  "publisher": "American Medical Association (AMA)",
  "ris": "https://research.draconitic.com/paper/fz51br1x7dghk.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:46Z",
      "native_id": "10.1001/jamanetworkopen.2026.38823",
      "source": "crossref",
      "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855260"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Acute Ischemic Stroke Management",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Thrombectomy for Acute Stroke Due to Medium Vessel Occlusion Across Perfusion Mismatch Profiles",
  "title_text": "Thrombectomy for Acute Stroke Due to Medium Vessel Occlusion Across Perfusion Mismatch Profiles",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:46Z",
  "url": "https://research.draconitic.com/paper/fz51br1x7dghk",
  "venue": "JAMA Network Open",
  "versions": []
}