There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Summary of Endovascular Treatment of Stroke due to Medium-Vessel Occlusion
- The endovascular treatment (EVT) of distal medium vessel occlusions (DMVOs) is a potential frontier of acute ischemic stroke (AIS) treatment, with recent studies suggesting its benefits even beyond the middle cerebral artery (MCA) - M2 segment 1, 2.
- A systematic review and meta-analysis found that EVT achieved significantly better odds of functional independence than best medical therapy (BMT) in primary DMVO, with no significant differences in overall excellent functional outcomes, symptomatic intracranial hemorrhage (sICH), and 90-day mortality 2.
- The microcatheter aspiration thrombectomy (MAT) technique has been shown to be technically feasible and effective for DMVOs in the MCA territory, with a successful revascularization rate of 58% and a good clinical outcome at discharge in 68% of patients 1.
- An international survey found that neurointerventionalists choose a targeted vessel-specific first-line approach depending on the occlusion location, region of practice, and availability of appropriate tools, with stent-retrievers, combined approaches, and aspiration only being the most preferred first-line endovascular approaches 3.
- A review of endovascular treatment for medium vessel occlusion stroke found that there is limited but promising evidence for the safety and efficacy of MeVO EVT, and many neurointerventionists are already routinely offering EVT for MeVO stroke despite the lack of clear guideline recommendations 4.
- Another study found that the safety and efficacy of EVT in acute ischemic stroke patients caused by large-vessel occlusion with different etiologies of stroke were similar among different etiologies of stroke, with cardioembolic and artery to artery embolism strokes being related to a higher rate of complete recanalization 5.
Key Findings
- EVT is beneficial for DMVO stroke, with improved functional independence and no significant increase in sICH or 90-day mortality 2.
- MAT is a feasible and effective technique for DMVOs in the MCA territory, with high successful revascularization and good clinical outcome rates 1.
- Neurointerventionalists prefer a targeted vessel-specific first-line approach for MeVO EVT, depending on occlusion location and availability of tools 3.
- There is limited but promising evidence for the safety and efficacy of MeVO EVT, with many neurointerventionists already offering EVT for MeVO stroke 4.
- The safety and efficacy of EVT in AIS patients caused by large-vessel occlusion with different etiologies of stroke are similar among different etiologies of stroke 5.