What sets the Oriental MeVO trial apart?
While several major trials were launched simultaneously (ESCAPE-MeVO, DISTAL, and DISCOUNT), the Oriental MeVO study adopted a unique inclusion criterion. It exclusively enrolled patients with a National Institutes of Health Stroke Scale (NIHSS) score equal to or greater than 6. This strategic choice was driven by evidence suggesting that stroke severity is a primary determinant of treatment benefit in mechanical thrombectomy.
Efficacy and key outcomes
The trial randomized patients into two distinct arms, thrombectomy versus control arm, with a primary endpoint follow-up at 90 days. The results demonstrated a clear benefit for endovascular intervention:
- Thrombectomy Arm: 58.6% of patients achieved functional independence (mRS 0–2).
- Control Arm: 46.8% of patients achieved functional independence.
This represents a significant 12% difference, establishing the clinical success of the procedure in this specific patient cohort.
Limitations and future perspectives
While Oriental MeVO stands out as a positive trial among its peers, Raul Nogueira highlights a few critical limitations to consider when translating these results globally:
- Demographics & etiology: Intracranial atherosclerotic disease (ICAD) is significantly more prevalent in Chinese populations.
- Vessel Distribution: Variations in the balance of M2 and M3 occlusions between the two arms.
- Thrombolysis rates: A lower percentage of patients received intravenous thrombolysis compared to the trials led in Europe (1/3 vs 2/3)
Looking ahead, Raul Nogueira emphasizes that the next logical step in stroke research will be to definitively demonstrate whether mechanical thrombectomy delivers superior outcomes compared directly to intravenous thrombolysis alone in MeVO patients.
