Fabiano Cavalcante, MD, is a PhD candidate at Amsterdam UMC and founder of Citadel Medical Sciences.

Prior intravenous thrombolysis (IVT) did not significantly modify the functional effects of endovascular therapy (EVT) in patients with 

medium and distal vessel occlusion (MDVO) stroke

, according to a new analysis of the DISTAL trial.

Intravenous Thrombolysis Does Not Modify Endovascular Therapy for MDVO Strokes

 in Seoul, South Korea, by Fabiano Cavalcante, MD, a PhD candidate at Amsterdam UMC and founder of Citadel Medical Sciences, these exploratory data may indicate that the threshold for procedural intervention in distal occlusions may be higher than previously believed.

“It’s very important that these results should be interpreted carefully,” Cavalcante told 

 in an exclusive interview. “I think they are more on the hypothesis-generating side than actually on the treatment decision side. We need more evidence from pooling these trials together to have a larger sample size or randomizing further patients, especially now that we know the results of the first 3 trials that didn’t show a clear benefit.”

DISTAL was an open-label, randomized trial conducted across 56 locations worldwide. Patients were eligible for inclusion if they had experienced an acute ischemic stroke and had evidence of a hypoperfusion-hypodensity mismatch, a diffusion-hyperintensity mismatch, and isolated medium vessel occlusion, among other criteria. Patients with acute intracranial hemorrhage, an in-hospital stroke, known history of arterial tortuosity or pre-existing stent, among other criteria, were excluded.

Patients were randomly assigned to receive either EMT on top of standard therapy, including IVT or antiplatelet therapy if indicated, or standard therapy alone. The primary endpoint was the degree of dependency and disability in everyday life at 90 days, which investigators measured via the modified Rankin Scale (mRS). Secondary endpoints included the change in National Institutes of Health Stroke Scale (NIHSS) at 24 hours post-randomization, assessment of cognitive function via the Montreal Cognitive Assessment (MoCA) at 90 days, and change in quality of life at 90 days.

A total of 543 patients were enrolled in DISTAL, of whom 271 were assigned to the treatment arm and 272 to the control arm. Median NIHSS score at admission was 6 (interquartile range [IQR], 5-9), and 355 patients received IVT. Predominant occlusion locations were the M2 (n = 239), M3 (n = 146), P2 (n = 73), and P1 (n = 30) segments.

By 12 months, investigators found no difference in the distribution of mRS scores between the groups (adjusted common OR 0.81; 95% CI, 0.59-1.12; 

 = .2). The median mRS score was 2 (IQR, 1-4) in the treatment group and 2 (IQR, 1-4) in the control group. In the treatment arm, 58 of 263 patients who completed the study showed an improvement of ≥1 point between 90 days and 12 months, compared to 56 of 261 patients in the control arm. Another 56 patients in the treatment arm and 47 in the control arm saw mRS scores worsen by ≤1 point.

In the present analysis, Cavalcante and colleagues included patients from the DISTAL trial with non-minor stroke, defined as NIHSS >5. The primary outcome of the analysis was functional status at 90 days, analyzed using adjusted ordinal regression. Interaction terms also assessed whether the treatment effect was modified by prior IVT use and by baseline NIHSS among those ineligible for IVT.

Of the 543 patients included in DISTAL, 319 had an admission NIHSS >5 and were included in the study. Of these, 216 received IVT. No significant interaction was observed between treatment assignment and prior IVT use for 90-day mRS (ratio of odds ratios [rOR], 0.56; 95% CI, 0.24-1.32; 

-interaction = 0.18). Among patients ineligible for IVT, however, Cavalcante and colleagues did see a significant interaction between treatment allocation and baseline NIHSS (rOR = 1.49; 95% CI, 1.18-1.9; 

-interaction <.001) with EVT associated with improved functional outcomes as stroke severity increased.

Ultimately, Cavalcante and colleagues concluded that prior IVT did not significantly modify the functional effect of EVT in these patients. Among those who were ineligible, however, the benefit of EVT was very dependent on baseline severity, appearing most favorable in those patients with moderate-to-severe deficits (NIHSS >10).

“At the level of hypothesis generation, I think these results do mean that we maybe need at least a moderately severe stroke to justify the risks of IVT procedures in a more fragile, more distal vessel, which carries risks of complications,” Cavalcante said. “But again, I think it’s very important to reiterate that this study does not define whether you should treat a patient based on the NIHSS or not.”

Editors’ Note: Cavalcante reports no relevant disclosures.

Cavalcante F. Endovascular Therapy for Non-Minor MDVO Stroke in Patients Ineligible for Intravenous Thrombolysis: A Secondary Analysis of the DISTAL Randomized Clinical Trial. Presented at the World Stroke Congress (WSC) 2026, Seoul, South Korea. October 21-23, 2026.

Fischer U, Brehm A, Ribo M, et al. Endovascular treatment for medium or distal vessel occlusion stroke (distal): 12-month outcomes of a multicentre, open-label, randomised trial. 

University Hospital, Basel, Switzerland. EnDovascular Therapu Plus Best Medical Treatment (BMT) Versus BMT Alone for MedIum VeSsel Occlusion sTroke (DISTAL). ClinicalTrials.gov Identifier: NCT05029414. Updated December 24, 2024. Accessed October 21, 2026. 

https://clinicaltrials.gov/study/NCT05029414

Videos

Fabiano Cavalcante, MD, discusses his secondary analysis of the DISTAL trial, which revealed minimal association between IVT and the effect of EVT in MDVO strokes.

News

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Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Stroke

On the HCPLive stroke page, resources on the topics of medical news and expert insight into CVA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on stroke medicine, and more.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Amy Yu, MD, MSc, is an associate professor of neurology at the University of Toronto and a senior scientist at the Sunnybrook Research Institute.

Non-stenotic carotid disease is not only common, but also associated with substantial risk after 

, comparable to patients with ≥50% stenosis.

Non-Stenotic Carotid Disease is Common, Substantially Increases Risk After Ischemic Stroke

 in Seoul, South Korea, by Amy Yu, MD, MSc, associate professor of neurology at the University of Toronto and senior scientist at the Sunnybrook Research Institute, these data challenge the traditional understanding of “clinically insignificant” stenosis.

“Carotid disease accounts for about 10% of all ischemic stroke, and we know that people with severe carotid stenosis should be treated with interventions for revascularization,” Yu told 

 in an exclusive interview. “The <50% carotid disease, the non-stenotic category, is really a mixed bag, and we’re now recognizing that some of these patients can go on to have high-risk stroke events or other kinds of major adverse cardiovascular events.”

Despite the clinical significance of non-stenotic carotid disease, it remains a relatively understudied pathology in stroke. Prior studies have identified imaging features of high-risk non-stenotic plaques, but as of July 2026, there is still no standardized definition of symptomatic non-stenotic carotid disease.

To address this, Yu and colleagues conducted a population-based study in Ontario using the Ontario Stroke Registry, specifically sourcing data from 2019-2023. Patients who were hospitalized with ischemic stroke within 24 hours of onset and who had a documented carotid stenosis severity of <50% or ≥50% were enrolled in the study and categorized by the highest degree per patient. The team compared outcomes such as in-hospital mortality and major adverse cardiovascular events (MACE) until 2025 by stenosis severity, utilizing modified Poisson and Cox regression models adjusted for demographics, stroke severity, and comorbidities.

A total of 15,796 patients were included in the study, among whom 78.5% had non-stenotic carotid disease (defined as stenosis severity <50%). Patients with <50% stenosis also had lower burdens of 

 risk factors like hypertension (81.7% vs 87.5%), diabetes (37.4% vs 43.7%), prior stroke (11.4% vs 14.7%), coronary artery disease (13.3% vs 22%), and smoking (13.5% vs 18.8%).

However, despite these differences, Yu and colleagues noted that event rates for ischemic stroke (9.4% vs 9.5%; adjusted HR, 0.96; 95% CI, 0.84-1.11) and myocardial infarction (2% vs 3.2%; aHR, 0.76; 95% CI, 0.59-1) were similar in both groups. In-hospital mortality also remained substantial across both populations, although it was numerically lower in those with ≥50% stenosis (adjusted risk ratio [RR], 0.77; 95% CI, 0.7-0.86). Long-term mortality risk was only modestly lower in patients with <50% stenosis (aHR, 0.83; 95% CI, 0.77-0.89).

Ultimately, Yu and colleagues concluded that these data, while relatively early and hypothesis-generating, still display the significant risk posed by non-stenotic carotid disease. Mortality and MACE risk in patients with <50% stenosis approached those seen in ≥50% stenosis, highlighting an underrepresented risk. The team determined that this population needs improved risk stratification and optimized disease management strategies.

“If we’re able to quantify long-term risks on a population basis, it’s really helpful for other people who want to plan future clinical trials or cohort studies to be able to know the outcome numbers that we’re looking at, and the sample size calculations, and so on,” Yu said. “I’m hoping that this study can provide a bit of background information and be hypothesis-generating for future studies as well.”

Editors’ Note: Yu reports no relevant disclosures.

Yu A. Non-Stenotic Carotid Disease is Not Benign: Comparable Risk to ≥50% Stenosis After Stroke. Presented at the World Stroke Congress (WSC) 2026, Seoul, South Korea. October 21-23, 2026.

Chu T, Soufi K, Castillo J, Moskalik A, Gerndt C, Cord BJ. Non-stenotic Carotid Disease: Review of the Literature and Case Discussion of TCAR for Treatment. Semin Neurol. 2026;46(4):367-373. 

Amy Yu, MD, MSc, discusses her presentation at WSC 2026 discussing highlighting the present danger of this underrepresented disease state.

 (CIndU) has long lacked approved therapies, leaving clinicians to rely on up-dosed antihistamines and off-label agents for a frequently persistent disease.

In this HCPLive Special Report, Andrea Nguyen, DMSc, MPAS, PA-C, of First OC Dermatology, spoke with Adam Friedman, MD, of George Washington University School of Medicine and Health Sciences, about how the approval of remibrutinib (Rhapsido),  an oral Bruton tyrosine kinase (BTK) inhibitor, for adults with symptomatic dermographism inadequately controlled by H1 antihistamines.

Experts discuss remibrutinib, the first FDA-approved therapy for symptomatic dermographism, and its role in chronic inducible urticaria.

Special Report: Remibrutinib, an Oral BTKi, for Chronic Inducible Urticaria

In the phase 3 RemIND trial, 115 adults with a mean disease duration of 5.8 years received remibrutinib 25 mg or placebo twice daily. At week 12, 29.3% (17/58) vs 14.0% (8/57) achieved a complete response on the Total Fric Score (P = .0229). Responses emerged by week 2, persisted through week 24, and held regardless of baseline total IgE.

A complete response means no wheal after standardized friction provocation, a stringent bar in easily provoked skin. This consistency across IgE levels supports broad applicability, unlike CSU, where IgE can predict response to omalizumab (Xolair).

Remibrutinib blocks BTK downstream of high-affinity IgE receptor cross-linking, halting mast cell degranulation whether activation is IgE- or IgG-mediated. Its efficacy in dermographism also suggests a BTK role in inducible mast cell activation.

Safety mirrored the REMIX trials in CSU, where petechiae occurred more often with remibrutinib than placebo (3.8% vs 0.3%).

 Mild mucocutaneous bleeding reflects BTK's role in platelet function, and no routine laboratory monitoring is required.

Collectively, the approval gives clinicians evidence-based footing in a long-neglected condition. Data from cold and cholinergic urticaria cohorts may extend the reach of BTK inhibition further.

Metz M, Giménez-Arnau A, Hide M, et al. Remibrutinib in chronic spontaneous urticaria. 

Novartis. Novartis Rhapsido (remibrutinib) receives FDA approval as first treatment for symptomatic dermographism (SD), expanding its use beyond chronic spontaneous urticaria (CSU). Published October 7, 2026. Accessed October 7, 2026. 

https://www.novartis.com/us-en/news/media-releases/novartis-rhapsido-remibrutinib-receives-fda-approval-first-treatment-symptomatic-dermographism-sd-expanding-its-use-beyond-chronic-spontaneous-urticaria-csu

Urticaria

The HCPLive urticaria page is a comprehensive resource for clinical news and insights on chronic idiopathic urticaria and chronic spontaneous urticaria. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for urticaria, and more.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Evan Dellon, MD, MPH, is a professor in the division of gastroenterology and hepatology and director of the Center for Esophageal Diseases and Swallowing at UNC School of Medicine.

Joy Chang, MD, MS, is an assistant professor of medicine in the division of gastroenterology at the University of Michigan in Ann Arbor.

Improving Diagnostic Evaluation in EoE

In this episode, ‘Improving Diagnostic Evaluation in EoE,’ the panelists explore how clinicians can recognize patients who warrant evaluation for eosinophilic esophagitis and improve the quality of the diagnostic workup. The experts emphasize that dysphagia and food impaction should clearly prompt further investigation, but adaptive eating behaviors may provide subtler clues. Patients may avoid problematic foods or normalize abnormal swallowing patterns because similar behaviors have developed gradually or are shared by family members.

The discussion then focuses on endoscopic evaluation. The panel explains that clinicians should assess for inflammatory findings such as edema, furrows, and exudates, as well as rings, strictures, reflux-related changes, and other potential causes of dysphagia. Importantly, a normal-appearing esophagus does not exclude EoE. Faculty stress that biopsies remain essential because disease can be patchy and visually subtle. They discuss obtaining multiple biopsies from different levels of the esophagus and using standardized EREFS documentation to objectively track endoscopic findings over time.

The experts also identify food impaction as an important diagnostic opportunity that is too often missed, particularly during urgent procedures. Failure to obtain biopsies may lead to patients being lost to follow-up once the acute obstruction is relieved. The panel highlights practical strategies for improving biopsy rates and emphasizes that systematic evaluation can shorten the interval between symptoms and diagnosis.

The next episode in this series, ‘Recognizing Progression and Fibrostenotic Disease in EoE,’ features the panelists discussing demographic misconceptions, diagnostic delay, and the

relationship between persistent inflammation and fibrostenotic progression.

Early EoE recognition depends on looking beyond overt dysphagia and performing an adequate diagnostic evaluation. Careful endoscopy and appropriately distributed biopsies can prevent missed opportunities for diagnosis.

Video Series

Understanding Epithelial Dysfunction and Symptom Adaptation in EoE

Welcome back to another HCP Live Peer Exchange series. In this episode titled, ‘Understanding Epithelial Dysfunction and Symptom Adaptation in EoE,’ the panel of experts examines the evolving understanding of eosinophilic esophagitis pathophysiology and the factors that contribute to delayed recognition of disease. The faculty discuss the esophageal epithelium as an active component of immune function rather than simply a passive barrier, emphasizing the bidirectional relationship between epithelial injury and type 2 inflammation. They explain how this broader understanding has shifted attention beyond the eosinophil toward upstream inflammatory pathways and other potential therapeutic targets.

The panel then explores why EoE care frequently remains symptom-driven despite the underlying chronic disease process. Faculty highlight barriers to specialty care and the challenge of relying on patients to recognize and report symptoms that may have developed gradually. They emphasize that patients often normalize dysphagia and develop compensatory eating behaviors, including drinking excessive fluids with meals, avoiding certain foods, chewing extensively, or taking longer to eat. Family members may recognize these changes before patients themselves appreciate their significance. The experts stress the importance of asking detailed questions about eating patterns and adaptive behaviors to uncover disease burden that may otherwise remain hidden.

In the next episode, ‘Improving Diagnostic Evaluation in EoE,’ panelists will continue their discussion on EoE and highlight clinical presentations that should prompt evaluation, along with best practices for endoscopy and esophageal biopsy.

EoE extends beyond eosinophilic inflammation, with epithelial barrier dysfunction helping perpetuate disease activity. Recognizing how patients adapt to chronic symptoms may be equally important for identifying disease earlier.

Michael Wechsler, MD, of National Jewish Health.

Michael Wechsler, MD, reports 59% of patients in clinical remission with twice-yearly depemokimab at year 1 maintained it at year 2 in SWIFT/AGILE.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Asthma

The HCPLive asthma page is a comprehensive resource for clinical news and insights on asthmatic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for allergic and severe asthma, and more.

Depemokimab Year 1 Remission Linked to Better Year 2 Asthma Outcomes

Frank Sciurba, MD, professor of medicine at the University of Pittsburgh School of Medicine.

Frank Sciurba, MD, reports tozorakimab improved E-RS:COPD scores vs placebo at week 52 in OBERON and TITANIA, including breathlessness and chest symptoms.

COPD

COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

Tozorakimab Improves Daily Respiratory Symptoms in COPD: OBERON, TITANIA

Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

Articles

A recent MRI analysis of the pivotal OCEANIC-STROKE trial has indicated a complete lack of association between infarct patterns and asundexian’s efficacy.

Asundexian Safely Reduces Ischemic Stroke Risk Regardless of Infarct Patterns on MRI

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for 

. He is also the executive producer of two podcasts: 

. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

AAD and HSF issued the first joint hidradenitis suppurativa guidelines, outlining 37 recommendations and flagging step therapy as a major barrier.

Hidradenitis Suppurativa

Hidradenitis Suppurativa condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatology research, treatment, and drug development.

AAD's New HS Guidelines Flag 'Step Therapy' as Top Barrier to Care

A new analysis of 4 major trials has revealed the association between lower SBP and higher TTR and the risk of recurrent stroke after intracerebral hemorrhage.

Hypertension

The HCPLive hypertension page is a resource for medical news and expert insights on high blood pressure. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for hypertension, and more.

TTR and Systolic Blood Pressure Load Control Improve Recurrent Stroke Risk

Data from the phase 2a BIRCH trial demonstrated the treatment’s improvements in mRS and NLR, positioning it for a late-phase trial in the future.

BIOX-101 Displays Safety and Efficacy in Spontaneous Intracerebral Hemorrhage

A new analysis of the BRIDGE-TNK trial has demonstrated that patients with cardioembolism are more likely to derive benefit than those with large artery atherosclerosis.

Stroke Etiology Modifies Tenecteplase’s Effect Before Endovascular Thrombectomy

Chelsie Derman is an associate editor for 

who covers allergy and  psychiatry. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Check out highlights from news published on day 3 of CHEST 2026, spanning COPD, pulmonary embolism, pulmonary hypertension, and AI.

CHEST 2026: Day 3 Recap — 6 Headlines to Know

Associate professor in the Division of Pulmonology and Department of Internal Medicine at the Medical University of Graz in Austria

Gabor Kovacs, MD, PhD, discusses phase 2a INSIGNIA PH-COPD results for inhaled frespaciguat presented at CHEST 2026.

Frespaciguat Misses 6MWD End Point in PH-COPD: Gabor Kovacs, MD, PhD

Professor, University of Kiel, Kiel, Germany | Medical Director, Velocity Clinical Research Grosshansdorf, Grosshansdorf, Germany

Henrik Watz, MD, discusses 104-week OBERON, TITANIA, and PROSPERO data on tozorakimab in COPD presented at CHEST 2026.

Latest News

Intravenous Thrombolysis Does Not Modify Endovascular Therapy for MDVO Strokes

Non-Stenotic Carotid Disease is Common, Substantially Increases Risk After Ischemic Stroke

Special Report: Remibrutinib, an Oral BTKi, for Chronic Inducible Urticaria

Improving Diagnostic Evaluation in EoE

Understanding Epithelial Dysfunction and Symptom Adaptation in EoE