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Two randomized trials in China reported better functional outcomes with endovascular therapy for selected patients with milder large-vessel strokes and for patients treated 24–72 hours after symptoms began. The studies also found safety concerns, including procedural complications, brain bleeding and deaths; other ongoing trials are expected to add evidence.
Two randomized trials conducted in China found that endovascular therapy (EVT), a procedure to remove a clot from a blocked brain artery, was associated with better functional outcomes in selected patients with milder strokes or treatment beginning 24 to 72 hours after symptoms started. Both studies also reported safety concerns, and their findings do not establish that the procedure should be used routinely in these groups.
In the MILD-MT trial, researchers compared EVT plus medical management with medical management alone for people with mild anterior-circulation ischemic strokes and large-vessel blockage. Participants were selected using perfusion imaging and treated within 24 hours of onset or last-known-well time. Among 300 people in the modified intention-to-treat analysis, 69.4% in the EVT group and 50.0% in the medical-care group had an excellent functional outcome at 90 days, defined as a modified Rankin Scale score of 0 or 1. The reported odds ratio was 2.32, with a 95% confidence interval of 1.41 to 3.81.
The MILD-MT researchers enrolled participants at 26 comprehensive stroke centers in China during 2024 and 2025. Symptomatic brain bleeding within 48 hours occurred in three patients in each group. However, serious procedure-related complications affected 13.2% of those receiving EVT; reported events included arterial dissection, bleeding into the space around the brain and clot movement to a new territory. The study also found less neurologic deterioration within seven days in the EVT group: 13.9%, compared with 31.4% among controls.
The LATE-MT trial examined patients with anterior-circulation large-vessel occlusion and imaging evidence of salvageable brain tissue 24 to 72 hours after symptom onset. EVT plus standard care was associated with better functional outcomes than standard care alone, with a reported common odds ratio of 1.74 (95% CI 1.19 to 2.55). Safety signals included symptomatic intracranial hemorrhage in 4.8% of EVT patients and none of the controls, as well as deaths by 90 days in 6.0% and 1.8%, respectively. The report says the trials were published in the New England Journal of Medicine.
Testing Stroke Treatment Boundaries
EVT can restore blood flow by removing a clot, but treatment decisions depend on the expected benefit and the risk of harm for each patient. The findings matter because they test whether selected patients outside familiar treatment patterns—those with relatively mild symptoms or those arriving much later—might also benefit. In MILD-MT, the lower rate of early neurologic deterioration adds to the functional-outcome result, while the 13.2% rate of serious procedural complications shows why benefits cannot be considered apart from risks.
The results are not a general instruction to perform thrombectomy in every mild stroke or after 24 hours. Both trials studied specific patient groups identified through imaging, and the late-treatment results came with differences in bleeding and mortality. The evidence may inform future guidance, but decisions about treatment still require clinicians to weigh a patient’s imaging, timing, clinical condition and potential harms.
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How the Trials Extend EVT Evidence
For nearly a decade, EVT has been used for selected patients with ischemic stroke caused by a large-vessel occlusion in the anterior circulation, generally within 24 hours of the time they were last known to be well. The source report says U.S. stroke guidance expanded eligibility earlier in 2026 to include patients with larger ischemic cores and those with basilar-artery occlusion, following additional evidence. The new trials examine further extensions: less severe initial symptoms and, in LATE-MT, a window extending to 72 hours for patients with salvageable tissue on imaging.
MILD-MT involved 300 people in its principal analysis, with a median baseline NIH Stroke Scale score of 4. The study selected patients with mild anterior-circulation strokes and substantial at-risk tissue. LATE-MT enrolled patients at 35 comprehensive stroke centers in China. The source material does not provide the full LATE-MT enrollment or detailed participant characteristics, so its results cannot be compared fully with MILD-MT from the information available here.
An accompanying editorial by Gaultier Marnat of Bordeaux University Hospital described the trials as important advances in testing EVT’s reach. He also pointed to treatment differences in LATE-MT: more than 10% of participants received intravenous thrombolysis despite the late time window, and a majority received anticoagulant or antithrombotic therapy within 24 hours after randomization. Those factors are relevant when interpreting the trial’s safety findings.
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Safety and Generalizability Questions
The findings leave open whether the benefits and risks will hold in other populations. Marnat noted that the results may not translate directly to non-Asian patients, among whom cardioembolism is a more common cause of large-vessel occlusion, according to the editorial. The report does not establish how EVT would perform across different healthcare settings or for patients who do not meet the trials’ imaging and clinical selection criteria.
Safety also needs further study. In MILD-MT, symptomatic bleeding was equal between groups, but serious procedure-related complications occurred in the EVT arm. In LATE-MT, the EVT group had higher reported rates of symptomatic intracranial hemorrhage and 90-day death. The editorial raised antithrombotic treatment as a possible consideration, but the source does not establish that it caused those outcomes. The balance of benefit and harm remains a key question, particularly for late treatment.
These are randomized trials, but their results are not proof that every patient with mild symptoms or a late presentation should receive EVT. The reported findings apply to the patients enrolled and the treatment approaches studied. Further evidence is needed to clarify which patients are most likely to benefit and how to reduce complications.
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More Trials Will Add Evidence
Further results are expected from the MOSTE and SELECT LATE trials, which the source report describes as ongoing in France and the United States. Those studies may help test whether the Chinese trial findings apply to other populations and clinical settings, and may clarify the selection of patients for treatment in mild-stroke and later-window scenarios.
Until those results are available, the reported studies add evidence for discussion rather than settling treatment policy. Clinicians and guideline groups will need to consider the functional outcomes alongside bleeding, death and procedural complications. The timing and findings of the ongoing trials are not specified in the source material.
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Key Questions
What is endovascular therapy for stroke?
Endovascular therapy is a procedure used to remove a clot blocking a large artery supplying the brain. The trials reported here compared it alongside medical care with medical care alone in selected patients.
What did the mild-stroke trial find?
In MILD-MT, 69.4% of patients assigned to EVT and medical management had an excellent functional outcome at 90 days, compared with 50.0% assigned to medical management alone. Serious procedure-related complications occurred in 13.2% of the EVT group.
How late after stroke did LATE-MT test treatment?
LATE-MT studied patients with imaging evidence of salvageable brain tissue 24 to 72 hours after symptom onset. EVT was associated with better functional outcomes, but the trial also reported more symptomatic brain bleeding and deaths in the EVT group.
Do these trials mean EVT is now recommended for all mild or late-presenting strokes?
No. The findings concern selected patients in two trials and do not establish routine treatment for everyone with mild symptoms or a late presentation. The safety signals and need for evidence from other populations remain relevant.
What evidence is expected next?
The source report identifies MOSTE and SELECT LATE as ongoing trials in France and the United States. Their results are expected to add evidence, but no publication dates or outcomes are provided.
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