Abstract 040: Meta‐Analysis of Randomized Controlled Trials Evaluating Mechanical Thrombectomy in Acute Ischemic Stroke: Functional Outcomes, Safety, and Recanalization Efficacy

Introduction/Purpose Mechanical thrombectomy has revolutionized the management of acute ischemic stroke due tolarge vessel occlusion (LVO). While individual randomized controlled trials (RCTs) have shownconsistent benefits, variability in patient selection, time windows, and outcomes warrants apooled evaluation. This meta‐analysis aims to quantitatively synthesize data from landmark RCTsto assess the efficacy and safety of mechanical thrombectomy across diverse clinical contexts. Materials/Methods A comprehensive literature search was conducted on PubMed, Cochrane Library, andClinicalTrials.gov for RCTs published between January 2015 and March 2024 . Inclusion criteria: • Prospective, randomized controlled trials comparing mechanicalthrombectomy ± standard care vs. standard medical therapy alone • Adult patients (≥18 years) with acute anterior circulation ischemic stroke • Reporting outcomes in terms of modified Rankin Scale (mRS), TICI score , NIHSS , mortality , and symptomatic intracranial hemorrhage (sICH) Meta‐analysis was performed using RevMan 5.4 and random‐effects model to calculatepooled risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI). I 2 statistic was used to assess heterogeneity. Results Nine RCTs involving 2,788 patients met inclusion criteria (including MR CLEAN, ESCAPE,REVASCAT, SWIFT PRIME, EXTEND‐IA, DAWN, DEFUSE‐3, SELECT, and SELECT2). Key pooledresults: • Functional independence (mRS ≤ 2 at 90 days) :RR = 2.08 ; 95% CI: 1.79–2.43; p < 0.0001 • Successful reperfusion (TICI 2b–3) :RR = 1.85 ; 95% CI: 1.54–2.21; p < 0.0001 • NIHSS improvement (mean difference) :MD = 4.2 points ; 95% CI: 2.7–5.6; p < 0.001 • 90‐day mortality :RR = 0.83 ; 95% CI: 0.69–1.01; p = 0.07 • Symptomatic ICH :RR = 1.11 ; 95% CI: 0.83–1.48; p = 0.49 Heterogeneity was low to moderate (I 2 = 30–55%) , with consistent benefit across both earlyand extended time windows (DAWN, DEFUSE‐3, SELECT2). Table 1. Pooled Meta‐Analysis Results of Key OutcomesOutcomePooled Estimate 95% CIp‐valueI 2 (%) mRS ≤ 2 at 902.081.79 – 2.43<0.000142%Days (RR)TICI 2b–31.851.54 – 2.21<0.000138%Recanalization(RR) NIHSS+4.2 points2.7 – 5.6<0.00131%Improvement(MD)90‐Day Mortality 0.830.69 – 1.010.0752%(RR)Symptomatic ICH 1.110.83 – 1.480.4934%(RR) Conclusion This meta‐analysis of nine landmark RCTs confirms that mechanical thrombectomy significantlyimproves functional outcomes and recanalization success in patients with LVO stroke, with aconsistent safety profile. The mortality benefit approaches statistical significance, and sICH ratesremain low. These findings strongly support thrombectomy as the standard of care across earlyand late treatment windows when guided by imaging.