RecentRCT

DISCOUNT

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

JAMA, 2026 · Randomized trial stopped at interim analysis

Population: 244 adults with medium/distal cerebral arterial occlusion
Intervention: Thrombectomy plus medical care
Comparator: Medical care
Primary outcome: mRS 0–2 at three months
Result: 62% versus 68%; OR 0.73 (95% CI 0.40–1.31), P=.29. Hemorrhage was more frequent after thrombectomy.

What the trial found

62% versus 68%; OR 0.73 (95% CI 0.40–1.31), P=.29. Hemorrhage was more frequent after thrombectomy.

Clinical interpretation

Do not extrapolate large-vessel thrombectomy benefit to routine medium/distal occlusion treatment. DISCOUNT showed no functional benefit; hemorrhage comparisons reported by actual treatment are not the randomized primary analysis.

Limitations

Apply only to the trial-defined population and outcomes; full protocol and subgroup appraisal remains in the audit ledger.

Moderate certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Acute Ischemic Stroke

Core vs penumbra dynamics, ASPECTS & CT perfusion, Tenecteplase/Alteplase thrombolysis, DAWN/DEFUSE 3 extended thrombectomy, BP targets, and malignant MCA hemicraniectomy.

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