ABSTRACT NUMBER: ESOC2026A2437 COMPARATIVE SAFETY AND EFFICACY OF CONSERVATIVE VERSUS ENDOVASCULAR MANAGEMENT OF ISOLATED EXTRACRANIAL INTERNAL CAROTID ARTERY STENO-OCCLUSIVE LESIONS DURING ACUTE ISCHEMIC STROKE: A SYSTEMATIC REVIEW META-ANALYSIS

Abstract Background and aims Isolated extracranial internal carotid artery (EC-ICA) stenosis or occlusion during acute ischemic stroke (AIS) represents a challenging clinical scenario with uncertain therapeutic strategy. Our aim was to conduct a meta-analysis summarizing the current evidence regarding therapeutic management approaches. Methods A systematic review and meta-analysis were conducted including acute ischemic stroke due to EC-ICA occlusion treated with endovascular therapy (EVT) or best medical treatment (BMT) to compare the efficacy and safety of both approaches. Searches were performed in PubMed, EMBASE, and Google Scholar. Methodological quality: Newcastle–Ottawa Scale. Random-effects models estimated pooled proportions and ORs with 95% CI. Meta-regression explored predictors of favorable outcome ([mRS] 0–2 at 90 days). Results Sixteen studies were included (n = 1,212 patients), 10 evaluating EVT and 6 BMT. In spite of milder strokes in BMT group (NIHSS 7.5±13.2 vs 13.2±7.1 in EVT), there was no significant difference between EVT (46%) and BMT (53%) in mRS at 90 days. Mortality was comparable (19% vs 17%), and symptomatic intracranial hemorrhage (sICH) rates were low in both groups. Meta-regression identified baseline NIHSS as the only independent predictor of functional outcome. Conclusions Our findings show that half of patients with acute isolated extracranial internal carotid artery disease achieve independence at 3 months, regardless of whether they are managed with EVT or BMT. Substantial imbalance in baseline characteristics between EVT and BMT cohorts precludes direct comparison of both approaches.EVT appears to be a safe and feasible option in selected patients. Randomized clinical trials are needed to confirm optimal acute treatment of EC-ICA. Conflict of interest Luis Manzano-Hernández: nothing to disclose