Abstract 4355624: Reperfusion Strategies For Medium And Distal Vessel Occlusion: A Systematic Review And Network Meta-Analysis.

Evidence on the most effective treatment for stroke due to distal and medium vessel occlusions (DMVOs) remains unclear, as existing meta-analyses compare heterogeneous groups. We conducted a network meta-analysis to directly and indirectly compare different treatments for DMVOs: We performed a comprehensive search of databases through April 2025 to identify studies comparing endovascular treatment (EVT) with other therapies in DMVOs. We included 31 studies with EVT, intravenous thrombolysis (IVT), medical management (MM), and conservative management (CM) groups, including 7500 patients. Outcomes assessed included 90-day favorable modified Rankin Scale (mRS0–2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.: Compared to CM, EVT was associated with a higher rate of mRS 0–2 (RR:2.79, CI:95% 1.28–6.11, p = 0.01), while MM and IVT showed no significant differences. For mRS 3–6, CM (RR:3.05, CI:95% 1.43–6.55, p = 0.004) and thrombolysisIVT (RR:1.34, CI:95% 1.01–1.77, p = 0.04) carried greater risk than EVT. MM (RR: 0.59, CI:95% 0.35–1.00, p = 0.0498), IVT (RR:0.57, CI:95% 0.29–1.10, p = 0.10), and CM (RR:0.14, CI:95% 0.005–4.16, p = 0.26) showed non-significant lower sICH risk compared to EVT. No significant differences were found in 90-day mortality.: EVT consistently showed a favorable profile for mRS 0–2 at 90 days, with a non-significant increase in sICH and in 90-day mortality. These findings support EVT to improve functional recovery in DMVOs.