A211 Endovascular thrombectomy for distal medium vessel occlusion stroke: a meta-analysis of randomized controlled trials

<h3>Introduction</h3> The efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) resulting from distal medium vessel occlusion (DMVO) remains uncertain. <h3>Aim of Study</h3> This systematic review and meta-analysis aimed to provide a comprehensive assessment of EVT in AIS due to DMVO, based on evidence derived from randomized controlled trials (RCTs). <h3>Method</h3> We systematically reviewed four electronic databases to find relevant studies. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated for categorical and continuous outcomes, respectively. Significant heterogenicity was resolved with leave-one-out influence analysis. <h3>Results</h3> There were 601 patients in EVT plus best medical treatment (BMT) group and 623 patients in BMT alone group. Findings showed a significantly higher rate of serious adverse events (RR=1.3, 95%CI: 1.1 – 1.5, P&lt; 0.01) and sICH (RR=3.3, 95%CI: 1.8 – 5.9, P&lt; 0.01) in thrombectomy than control group. There was no significant difference between two groups in 90-day mRS 0–1, mRS 0–2, and mortality. Subgroup analysis, including the three DMVO trials and the two secondary analyses of previous LVO RCTs, confirmed the prior findings. Leave-one-out influence analysis showed no significant heterogeneity in any primary and secondary outcomes. <h3>Conclusion</h3> Our findings indicate that while EVT does not provide a significant advantage over BMT alone in improving functional outcomes for patients with DMVO, it is associated with an increased risk of hemorrhagic complications. These results underscore the importance of a cautious approach when considering EVT for DMVO and emphasize the need for further RCTs to optimize treatment strategies. <h3>Conflict of Interest</h3> No