Thrombectomy Reconsidered for Distal Occlusion Stroke

New data suggest thrombectomy may benefit carefully selected patients with distal and medium vessel occlusion stroke, challenging conclusions from earlier negative trials.

Published on Feb. 11, 2026

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Two new randomized trials are reopening the question of whether thrombectomy may benefit selected patients with acute ischemic stroke caused by distal or medium vessel occlusions, a population in which earlier studies failed to demonstrate clear clinical benefit. The ORIENTAL MeVO trial found that thrombectomy was associated with better functional outcomes among patients with distal or medium vessel occlusion and moderate-to-severe neurologic deficits. The DISTALS trial demonstrated high reperfusion rates and acceptable safety outcomes in carefully selected patients treated with a device specifically engineered for smaller vessels.

Why it matters

Mechanical removal of the clot by thrombectomy has transformed the treatment of stroke caused by large vessel occlusion in the last decade, but recent attempts at using this procedure to target clots in the smaller distal arteries have not been successful. These new studies suggest this technique may be possible in certain patients or with a new type of device more suitable for access to these smaller arteries.

The details

The ORIENTAL MeVO trial enrolled 564 patients with medium vessel occlusion stroke, baseline NIHSS scores ≥ 6, and presentation within 24 hours of symptom onset. Patients were randomized to thrombectomy plus standard medical management or standard medical management alone. The primary endpoint - functional independence (mRS 0-2) at 90 days - was achieved by 58.6% of the thrombectomy group compared to 46.6% of the control group. The DISTALS trial enrolled 149 patients with distal vessel occlusion stroke who were ineligible for thrombolysis and presented within 24 hours. Patients were assigned to thrombectomy with the Tigertriever 13 device or to medical management alone. The primary endpoint of successful reperfusion at 24 hours without symptomatic ICH was achieved in 86.3% of the thrombectomy group vs 27.7% of the control group.

  • The ORIENTAL MeVO trial was conducted at 48 centers in China.
  • The DISTALS trial enrolled patients who presented within 24 hours of symptom onset.

The players

Raul Nogueira

An investigator in the ORIENTAL MeVO trial and director of the stroke unit at the University of Pittsburgh Medical Center.

Rishi Gupta

A vascular neurologist at Wellstar Health System in Marietta, Georgia who presented the DISTALS trial.

Michael Hill

The director of the Stroke Unit at the Calgary Stroke Program, Alberta Health Services, Canada.

Tigertriever 13

A low-profile device developed by Rapid Medical for distal medium vessel occlusions, designed to allow manual control of expansion and deflation to better match vessel diameter.

Rapid Medical

The company that developed the Tigertriever 13 device.

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What they’re saying

“The magnitude of benefit was substantial. For every 100 patients treated, 54 had a less disabled outcome than with medical management alone. In addition, 12 more achieved functional independence, giving a number needed to treat of just eight, which is very low.”

— Raul Nogueira, Investigator, ORIENTAL MeVO trial (Medscape Medical News)

“They clearly showed that thrombectomy works in a more severely affected population with distal/medium vessel occlusions but was not effective if the NIHSS was below 8. In addition, patients were treated relatively early (under 6 hours from onset in most cases).”

— Michael Hill, Director, Stroke Unit, Calgary Stroke Program (Medscape Medical News)

“From a technical standpoint, it looks like this is a step forward. This technology may provide a safer and more effective treatment in comparison with other modalities. But this is a relatively small study, and we still need to wait to see if there was a clinical benefit.”

— Raul Nogueira, Investigator, ORIENTAL MeVO trial (Medscape Medical News)

What’s next

Further trials in this patient population are currently ongoing.

The takeaway

These new studies suggest that thrombectomy may benefit carefully selected patients with distal and medium vessel occlusion stroke, challenging conclusions from earlier negative trials and potentially expanding the use of this transformative stroke treatment.