Evidence map›Paper›PMID 40908129›Full record

Trial reportJournal of neurointerventional surgery2026

Clinical outcomes and independently adjudicated results of M2 aspiration thrombectomy: a subgroup analysis from the Imperative Trial.

Justin R Mascitelli, Reade Andrew De Leacy, William Mack, Raul Nogueira, Shahram Majidi, Robert Dana Tomalty, Maxim Mokin, Jan Vargas, Brett L Cucchiara, Kenneth V Snyder and 21 more

Abstract readMulticenter StudyClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of neurointerventional surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

31 authors.

Justin R MascitelliDepartment of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA jmascite@gmail.com.ORCID http://orcid.org/0000-0001-9409-5810
Reade Andrew De LeacyDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.ORCID http://orcid.org/0000-0001-9447-5338
William MackDepartment of Neurosurgery, Keck School of Medicine of USC Los Angeles, Los Angeles, California, USA.
Raul NogueiraDepartment of Neurology and Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
Shahram MajidiDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.ORCID http://orcid.org/0000-0003-2971-6216
Robert Dana TomaltyHuntsville Hospital, Huntsville, Alabama, USA.
Maxim MokinDepartment of Neurosurgery, University of South Florida, Tampa, Florida, USA.
Jan VargasDepartment of Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA.ORCID http://orcid.org/0000-0001-7164-1479
Brett L CucchiaraDepartment of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Kenneth V SnyderDepartment of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.ORCID http://orcid.org/0000-0002-0842-9026
Victoria ParadaDepartment of Neurology, Valley Baptist Medical Center/University of Texas Rio Grande Valley, Harlingen, Texas, USA.
Hakeem J ShakirDepartment of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.ORCID http://orcid.org/0000-0003-4234-340X
David Rosenbaum-HaleviDepartment of Neurosurgery, Munson Medical Center, Traverse City, Michigan, USA.
Amin AghaebrahimNeurological Institute, Lyerley Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA.ORCID http://orcid.org/0000-0002-9126-2932
Daniel HoitDepartment of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Benjamin YimDepartment of Neurosurgery, John Muir Health Medical Center, Walnut Creek, California, USA.
Matthew S TenserDepartment of Neurosurgery, University of Southern California, Los Angeles, California, USA.
Alhamza R Al-BayatiDepartment of Neurology and Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
James M MilburnDepartment of Radiology, Ochsner Medical System, New Orleans, Louisiana, USA.ORCID http://orcid.org/0000-0003-3403-2628
Shahid M NimjeeDepartment of Neurological Surgery, Ohio State University, Columbus, Ohio, USA.ORCID http://orcid.org/0000-0002-0317-8731
Neil HaranhalliDepartment of Neurological Surgery, Montefiore Medical Center, New York, New York, USA.
Michael NahhasDepartment of Neurology, UTHealth McGovern Medical School, Houston, Texas, USA.ORCID http://orcid.org/0000-0001-8198-7676
Darryn ShaffDepartment of Neurointerventional Radiology, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
Kennith F LaytonDepartment of Neurointerventional Radiology, Baylor University Medical Center, Dallas, Texas, USA.
Narlin BeatyDepartment of Neurosurgery, Tallahassee Memorial Hospital, Florida State University, Tallahassee, Florida, USA.
Robert M StarkeDepartment of Neurosurgery, University of Miami Health System, Miami, Florida, USA.
Harris HawkDepartment of Neurosurgery, Erlanger Health System, Chattanooga, Tennessee, USA.
Diogo C HaussenDepartment of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Aqueel PabaneyDepartment of Neurosurgery, Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
Christopher Paul KellnerDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.ORCID http://orcid.org/0000-0003-4604-8205
Jonathan A GrossbergDepartment of Neurosurgery, Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.ORCID http://orcid.org/0000-0002-1152-8826

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe ESCAPE-MeVO (Endovascular Treatment to Improve Outcomes for Medium Vessel Occlusions) and DISTAL (Endovascular Therapy plus Best Medical Treatment vs Best Medical Treatment Alone for Medium Vessel Occlusion Stroke) trials failed to demonstrate the superiority of endovascular thrombectomy over best medical management for medium and small vessel occlusions. Potential limitations of these trials include older patient populations, lower presenting National Institutes of Health Stroke Scale (NIHSS) scores, higher rates of premorbid disability, delayed revascularization times, inclusion of both medium and small vessel occlusions, and widespread use of stent retrievers. Here we present M2 occlusion data from the Imperative Trial, evaluating aspiration thrombectomy with the Zoom System.

methodsThe Imperative Trial is a prospective, multicenter, single-arm trial with independent core lab and safety board adjudication, evaluating aspiration thrombectomy with the Zoom System (Imperative Care, Campbell, CA, USA) for large vessel, including M2, occlusions. This subanalysis includes patients with primary M2 occlusions. Angiographic outcomes were defined as modified Treatment in Cerebral Infarction (mTICI) score ≥2b (good) and ≥2c (excellent). Clinical outcomes were defined as modified Rankin Scale score (mRS) 0-2 (good) and 0-1 (excellent) at 90 days. Safety was assessed by all-cause mortality, symptomatic intracranial hemorrhage (sICH), and all hemorrhage.

resultsOf 260 enrolled patients, 25% (65/260) had primary M2 occlusions. Median age was 69 years; median NIHSS was 13. Good and excellent reperfusion were achieved in 88% (57/65) and 66% (43/65), respectively. At 90 days, good and excellent clinical outcomes occurred in 62% (39/63) and 56% (35/63), respectively. Mortality, sICH, and any hemorrhage were 4.6% (3/65), 1.5% (1/65), and 18% (12/65), respectively.

conclusionsThe Zoom System demonstrated excellent safety and efficacy in M2 occlusions. These findings support aspiration thrombectomy for M2 occlusions as a viable treatment in well-selected patients.

Indexed as

Endovascular ProceduresStrokeThrombectomyAgedFemaleHumansMaleMiddle AgedProspective StudiesTreatment OutcomeCatheterReperfusionStrokeThrombectomy

Identifiers

PMID40908129
PMCPMC13479623

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.