6 February 2025
Catheter therapy for stroke caused by occlusion of smaller vessels shows no benefit
Endovascular catheter therapy for treating stroke has been shown to improve outcomes for patients with large vessel occlusions. However, a benefit could not be demonstrated when the stroke was caused by the occlusion of a medium or small vessel. This is the main result of the DISTAL study recently published in the New England Journal of Medicine.
A total of 543 stroke patients participated in the DISTAL study between 2021 and 2024. They were treated in 55 acute-care hospitals in 11 countries in Europe and the Middle East. Under investigation was the application of endovascular therapy, in which a catheter is guided through the bloodstream to the occlusion to remove the blood clot, in combination with standard drug therapy, in comparison with standard drug therapy alone.
No difference between the two treatment groups
Measured 90 days after the stroke occurred, the initial results show no difference in the extent of impairment or mortality between the two treatment groups. In both groups, about 45 per cent of the patients suffered moderate to severe impairment or died. This means that at present no clear recommendation can be made for the use of endovascular therapy for strokes caused by medium or small vessel occlusion, even though the study also showed that endovascular therapy is not associated with an increased risk of complications, including severe cerebral haemorrhage.
![[Translate to English:] Marios Psychogios](/fileadmin/_processed_/7/1/csm_Psychogios_Marios_2021_2d9a00f1f8.jpg?1738682855)
«Our study shows that endovascular therapy cannot yet be recommended as standard treatment for medium and smaller vessel occlusions. Nevertheless, it remains an option in special cases, as no increased risks have been identified.»
Prof. Dr. med. Marios Psychogios
Further research is indicated
The researchers now aim to further analyse the study results to determine whether specific subgroups of patients could benefit from endovascular therapy. Additionally, they plan to investigate imaging markers to improve individualised treatment decisions. The findings of the DISTAL study provide important insights for clinical stroke treatment and highlight the need for further research to improve treatment outcome.
![[Translate to English:] Urs Fischer](/fileadmin/_processed_/b/b/csm_Fischer-Urs_2022_web_32cad6e031.jpg?1738683247)
"The results highlight the urgent need for new, effective therapies, as the prognosis for these patients is significantly worse than previously assumed."
Prof. Dr. med. Urs Fischer
![[Translate to English:] stent](/fileadmin/_processed_/7/5/csm_AdobeStock_774498951_Stent_HD_0a4b2bc34e.jpg?1738681781 "Interventional cardiology. Surgeon doctor at operation. Stent and catheter for implantation into blood vessels with an empty and filled balloon.")
DISTAL study
EnDovascular therapy plus best medical treatment (BMT) versus BMT alone for MedIum VeSsel Occlusion sTroke - a prAgmatic, international, multicentre, randomised triaL (DISTAL)
Principal Investigators
Prof. Marios-Nikos Psychogios, Head of diagnosic and interventional Neuroradiology, and Prof. Urs Fischer, Inselspital Bern, former chief physician Neurology, USB
Study design
International, multicentre, pragmatic, randomised clinical study
Study sites
55 centres in Switzerland, Germany, Belgium, Portugal, Spain, Finland, Israel, Italy and Sweden
Number of participants
543
Project duration
2021-2026
DKF Scientific Services
Initially: Methodological Consulting, Regulatory Affairs
Ongoing: Statistics, Data Management, Monitoring, Project Management
Funding
SNF IICT