Two recent studies evaluated endovascular treatment (EVT) for stroke involving occlusion of medium or distal vessels. In the DISTAL study, researchers randomized patients with an isolated occlusion of medium or distal vessels to receive EVT and best medical treatment or to receive best medical treatment only within 24 hours of the patient last being seen well. The analysis included 543 patients with a median score on the National Institutes of Health Stroke Scale of 6. In all, 65.4% of the patients received intravenous thrombolysis. At 90 days, the researchers found no significant different in the distribution of modified Rankin scale scores between the EVT plus best medical treatment group and the best medical treatment only group. Rates of all-cause mortality and the incidence of symptomatic intracranial hemorrhage were also similar between the two groups. In the ESCAPE-MeVO study, meanwhile, researchers randomized patients with acute ischemic stroke due to medium-vessel occlusion who presented within 12 hours of the time they were last known to be well, with favorable baseline noninvasive brain imaging, to receive EVT plus usual care or to only usual care.  The multinational study included 530 patients, most of whom had primary occlusions in a middle-cerebral-artery branch. At 90 days, 41.6% of the 255 patients in the EVT group had a modified Rankin scale score of 0 or 1 compared with 43.1% of 274 patients in the usual-care group. The 90-day mortality rates were 13.3% and 8.4%, respectively. Symptomatic intracranial hemorrhage occurred more frequently in the EVT group compared with the usual-care group, at 5.4% vs. 2.2%. In the two studies, researchers concluded that EVT treatment for this patient population did not lead to better outcomes at 90 days compared with usual care alone.