ABSTRACT NUMBER: ESOC2026A1433 ENDOVASCULAR TREATMENT IN MINOR ACUTE ISCHAEMIC STROKE DUE TO LARGE VESSEL OCCLUSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Endovascular therapy (EVT) is frequently performed in routine care for patients with acute ischaemic stroke (AIS) and minor symptoms (NIHSS<6), despite scarce evidence supporting its safety and efficacy. This study aims to evaluate whether EVT with best medical treatment (BMT) provides clinical benefit compared to BMT-alone in patients with minor-AIS and large-vessel occlusion (LVO). Methods We performed a systematic search of MEDLINE, SCOPUS, and conference proceedings through January 3, 2026. Eligible studies included randomised or observational cohort studies enrolling patients with LVO-AIS and NIHSS<6, comparing EVT with BMT-alone. Meta-analysis was performed using the random-effects model and calculating pooled odds ratios (ORs). Results Eighteen observational studies were included, comprising a total of 4,604 patients treated with EVT versus 5,675 patients treated with BMT alone. EVT was not associated with excellent functional outcome (mRS 0-1; OR: 1.12; 95%CI: 0.86-1.46; p=0.39; 17 studies), good functional outcome (mRS 0-2; OR: 1.02; 95%CI: 0.77-1.35; p=0.89; 16 studies) or reduced disability at 90 days (≥1-point mRS improvement; common OR: 0.81; 95%CI: 0.57-1.17; p=0.27; 7 studies). Symptomatic intracranial haemorrhage was more common in the patients receiving EVT (OR: 3.01; 95%CI: 2.03-4.46; p<0.01; 14 studies). No association was observed between EVT and 90-day mortality (OR: 1.24; 95%CI: 0.86-1.79; p=0.25; 16 studies). Conclusions Pooled evidence from observational studies does not support EVT over BMT in patients with LVO-AIS and minor symptoms. Ongoing randomized-controlled clinical trials are needed to clarify the safety and efficacy of EVT in this population. Conflict of interest Nothing to disclose.