ABSTRACT NUMBER: ESOC2026A2017 SELECTIVE INTRA-ARTERIAL MILD COOLING VERSUS SYSTEMIC DEEP HYPOTHERMIA POST-EVT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Therapeutic hypothermia has been explored as a neuroprotective strategy after endovascular therapy for large-vessel occlusion, but results remain heterogeneous due to different cooling techniques. This first meta-analysis evaluates efficacy and safety by stratifying hypothermia methods and temperature targets to reduce heterogeneity. Methods We performed a systematic search through December 2025 to identify studies comparing selective hypothermia using intra-arterial mild cooling (IAMC), moderate whole-body hypothermia (MWB), deep whole-body hypothermia (DWB), and spontaneous hypothermia (SH) versus normothermia in post-EVT patients. Primary outcomes included good functional outcome at 90 days (mRS 0–2), intracranial hemorrhage (ICH), pneumonia, and mortality. Results Twelve studies were included (5 RCTs and 7 observational; 1,935 patients). Compared with normothermia, IAMC was associated with a higher likelihood of achieving mRS 0–2 (RR 1.48, 95% CI 1.21–1.81, p=0.0001), with non-significant reductions in ICH (RR 0.79, p=0.30) and mortality (RR 0.91, p=0.66). DWB was associated with a reduced risk of intracranial hemorrhage (RR 0.33, p=0.004), MWB with increased pneumonia risk (RR 2.98, 95% CI 1.58–5.62, p=0.0007), and SH with increased mortality (RR 1.40, 95% CI 1.11–1.76, p=0.004). Conclusions These findings suggest that selectivity of cerebral cooling, rather than the depth of hypothermia or its systemic application, may be the key determinant of neuroprotective benefit after thrombectomy. Selective hypothermia using IAMC offers the most favorable balance between functional efficacy and safety, and warrants evaluation in randomized clinical trials. Conflict of interest Amiel Armando Aragon Cortes. Nothing to disclose Figure 1 - belongs to Results Figure 2 - belongs to Conclusions