ABSTRACT NUMBER: ESOC2026A557 ADJUNCTIVE HYPOTHERMIA AFTER ENDOVASCULAR REPERFUSION THERAPY FOR ACUTE ISCHEMIC STROKE: EVIDENCE FROM A META-ANALYSIS

Abstract Background and aims Endovascular thrombectomy (EVT) is the standard of care for acute ischemic stroke due to large vessel occlusion; however, reperfusion injury limits neurological recovery. Selective or mild therapeutic hypothermia has emerged as a potential neuroprotective adjunct to EVT, aiming to mitigate ischemia-reperfusion injury while preserving procedural safety. Methods We conducted a systematic review and meta-analysis of clinical studies evaluating therapeutic hypothermia combined with EVT in patients with acute ischemic stroke. PubMed, Embase, Scopus, and Web of Science were searched from inception to December 2025. Primary outcomes were favorable functional outcome (modified Rankin Scale [mRS] 0–2 at 90 days). Secondary outcomes included excellent functional outcome (mRS 0–1), mortality, and symptomatic intracranial hemorrhage (sICH). Results Seven studies comprising 603 patients were included, of whom 294 received therapeutic hypothermia combined with EVT and 309 underwent thrombectomy alone. The addition of hypothermia was associated with a significantly higher rate of favorable functional outcome at 90 days (mRS 0–2: 59.2% vs 49.2%; RR= 1.23, 95% CI 1.06–1.42). Patients treated with hypothermia also demonstrated a greater likelihood of excellent functional recovery (mRS 0–1: 48.6% vs 33.1%; RR= 1.45, 95% CI 1.12–1.88). There were no significant differences between groups in mortality (RR= 0.97, 95% CI 0.75–1.26) or symptomatic intracranial hemorrhage (RR= 0.78, 95% CI 0.50–1.21). Statistical heterogeneity was low to moderate across outcomes. Conclusions Therapeutic hypothermia combined with EVT is associated with improved functional outcomes without increased mortality or hemorrhagic risk. Larger randomized trials are needed to confirm efficacy and optimize cooling strategies. Conflict of interest Khalid Sarhan: nothing to disclose. Rashad Gamaleldin Mohamed Rashad Mohamed: nothing to disclose.