Reperfusion therapy in pregnant and postpartum women after ischemic stroke: a systematic review and single-arm meta-analysis

PURPOSE: Ischemic stroke during pregnancy and postpartum represents a rare but severe clinical event. Although reperfusion therapies like intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are standard in the general population, their use in pregnant and postpartum patients remains controversial due to limited data. Therefore, this study aims to evaluate the safety and efficacy of reperfusion therapy in pregnant and postpartum women with acute ischemic stroke. METHODS: Systematic review and single-arm meta-analysis of studies reporting outcomes in pregnant or postpartum women undergoing IVT or MT. Outcomes included maternal and fetal events, intracerebral hemorrhage (ICH), symptomatic ICH (sICH), functional recovery (mRS 0-2), and mortality. RESULTS: Six studies comprising 275 patients were included. The pooled proportion of good maternal outcomes at discharge was 50% (95% CI: 44%-56%), and 85% (95% CI: 53%-100%) achieved functional recovery at 3 months. In-hospital mortality was 0% (95% CI: 0%-1%). Hemorrhagic complications included 10% ICH (95% CI: 1%-20%) and 3% sICH (95% CI: 0%-9%). Good fetal outcomes were observed in 78% (95% CI: 50%-100%) of cases. CONCLUSION: Although limited, the results suggest that reperfusion therapy in pregnancy-related ischemic stroke is safe and potentially effective, with favorable maternal and fetal outcomes and low mortality rates. These findings support the use of reperfusion therapies associated with individualized decision-making-in line with European Stroke Organisation guidelines -, emphasizing that pregnancy and post-partum period should not be a contraindication to IVT or MT.