Thrombectomy for Acute Stroke Due to Medium Vessel Occlusion Across Perfusion Mismatch Profiles

@article{pensato2026thrombectomy,
  title = {{Thrombectomy for Acute Stroke Due to Medium Vessel Occlusion Across Perfusion Mismatch Profiles}},
  author = {Umberto Pensato and Gunjan Jindal and William Diprose and Aravind Ganesh and Pattarawut Charatpangoon and Ethan MacDonald and Alexander Stebner and Salome Bosshart and Dar Dowlatshahi and David Volders and James Kennedy and Markus Möhlenbruch and Brian H. Buck and Shahid Nimjee and Thomas Booth and Mouhammad Jumaa and Jai J. Shankar and Franziska Dorn and Andrew M. Demchuk and Mayank Goyal and Michael D. Hill and Johanna M. Ospel and ESCAPE-MEVO Investigators and Jennifer Mandzia and Sachin Pandey and Jesse Klostranec and Lissa Peeling and Joanna Schaafsma and Timo Krings and Atif Zafar and Ravinder-Jeet Singh and Demetrios Sahlas and Thalia Field and Richard Swartz and Pual (Inder) Singh and Koji Ebersole and Shahid Nimjee and Negar Asdashi and Dileep Yavagal and Reade De Leacy and George Lopez and Babak Jahromi and Ronald Budzik and Seon-Kyu Lee and Eric Sauvageau and Adewumi Amole and Maxim Mokin and Mchael Levitt and Jason Tarpley and Albert Yoo and Michael Chen and Thanhn Nguyen and Santiago Ortega-Gutierrez and Adnan Siddiqui and Fabio Settecase and Thien Huynh and Tufail Patankar and Levansri Makalanda and Paul Burns and Changez Jadun},
  journal = {JAMA Network Open},
  year = {2026},
  month = oct,
  doi = {10.1001/jamanetworkopen.2026.38823},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855260},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Thrombectomy for Acute Stroke Due to Medium Vessel Occlusion Across Perfusion Mismatch Profiles
AU  - Umberto Pensato
AU  - Gunjan Jindal
AU  - William Diprose
AU  - Aravind Ganesh
AU  - Pattarawut Charatpangoon
AU  - Ethan MacDonald
AU  - Alexander Stebner
AU  - Salome Bosshart
AU  - Dar Dowlatshahi
AU  - David Volders
AU  - James Kennedy
AU  - Markus Möhlenbruch
AU  - Brian H. Buck
AU  - Shahid Nimjee
AU  - Thomas Booth
AU  - Mouhammad Jumaa
AU  - Jai J. Shankar
AU  - Franziska Dorn
AU  - Andrew M. Demchuk
AU  - Mayank Goyal
AU  - Michael D. Hill
AU  - Johanna M. Ospel
AU  - ESCAPE-MEVO Investigators
AU  - Jennifer Mandzia
AU  - Sachin Pandey
AU  - Jesse Klostranec
AU  - Lissa Peeling
AU  - Joanna Schaafsma
AU  - Timo Krings
AU  - Atif Zafar
AU  - Ravinder-Jeet Singh
AU  - Demetrios Sahlas
AU  - Thalia Field
AU  - Richard Swartz
AU  - Pual (Inder) Singh
AU  - Koji Ebersole
AU  - Shahid Nimjee
AU  - Negar Asdashi
AU  - Dileep Yavagal
AU  - Reade De Leacy
AU  - George Lopez
AU  - Babak Jahromi
AU  - Ronald Budzik
AU  - Seon-Kyu Lee
AU  - Eric Sauvageau
AU  - Adewumi Amole
AU  - Maxim Mokin
AU  - Mchael Levitt
AU  - Jason Tarpley
AU  - Albert Yoo
AU  - Michael Chen
AU  - Thanhn Nguyen
AU  - Santiago Ortega-Gutierrez
AU  - Adnan Siddiqui
AU  - Fabio Settecase
AU  - Thien Huynh
AU  - Tufail Patankar
AU  - Levansri Makalanda
AU  - Paul Burns
AU  - Changez Jadun
PY  - 2026
DA  - 2026/10/13
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.38823
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855260
AB  - 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.  Objective: 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.  Design, 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.  Interventions: Randomization to EVT plus usual care vs usual care alone.  Main 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.  Results: 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.  Conclusions 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.  Trial Registration: ClinicalTrials.gov Identifier: NCT05151172
SN  - 2574-3805
ER  -