Mechanical Thrombectomy in Ischemic Stroke With a Medium or Distal Arterial Occlusion: The DISCOUNT Randomized Clinical Trial.

In the DISCOUNT randomized trial for acute ischemic stroke from primary medium or distal arterial occlusions, thrombectomy did not improve 3-month good outcomes (62% vs 68%; P=.29).

• Why it matters: Benefit and safety of thrombectomy for primary and isolated medium or distal vessel occlusions are uncertain, leaving clinicians without clear evidence for this subgroup.
• What they did: Across 22 French stroke centers (Nov 2021–Apr 2025), adults were randomized to thrombectomy plus medical care (n=123) or medical care alone (n=121) within 8 hours of onset (or 24 hours if no FLAIR hyperintensity).
• The result: Among those actually treated, symptomatic intracranial hemorrhage was higher after thrombectomy (11% vs 3%; P=.008), with more subarachnoid hemorrhage (13% vs 2%; P<.001) and embolus migration (5% vs 1%; P=.04), while mortality was similar (6% vs 8%; P=.49).

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