ABSTRACT NUMBER: ESOC2026A1742 THE ROLE OF CEREBRAL SMALL VESSEL DISEASE IN CLINICAL AND RADIOLOGICAL OUTCOMES FOLLOWING REVASCULARIZATION THERAPIES IN ACUTE ISCHEMIC STROKE: SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOL

Abstract Background and aims Stroke remains a leading cause of death and disability worldwide, with a growing ischemic stroke burden despite declining mortality with intravenous thrombolysis (IVT) and endovascular therapy (EVT). Cerebral small vessel disease (CSVD), accounts for a substantial proportion of strokes and dementia. CSVD features may influence functional outcomes, hemorrhagic complications and tissue salvage after reperfusion. Using the updated STRIVE-2 definitions, we aim to synthetise the existing evidence on the impact of CSVD on outcomes after acute revascularisation in acute ischemic stroke (AIS). Methods This protocol follows PRISMA-P. We will search MEDLINE (Ovid ALL), Embase and CENTRAL from 2013 onwards, with PRESS-peer-reviewed search strategies and citation searching. Eligible studies include adult AIS cohorts with MRI-defined CSVD features per STRIVE-2 definitions, treated with IVT and/or EVT, and reporting mRS outcomes. Primary outcome is good functional outcome at 90 days (mRS 0-2); secondary outcomes include excellent functional outcome (mRS 0-1), mRS shift, symptomatic intracranial hemorrhage and final infarct size when available. Risk of bias will be assessed with ROBINS-I (non-randomized) or RoB 2 (randomized controlled trials), evidence quality with GRADE. Results Where homogeneous, we will pool adjusted effect estimates using random-effects meta-analysis (REML). Heterogeneity (I2) will be explored via subgroup analysis/meta-regression by CSVD feature/severity, treatment type, occlusion site, baseline NIHSS, and region. Publication bias will be assessed with funnel plots and Egger’s test. Conclusions This review will provide the first synthesis applying STRIVE-2 to evaluate how CSVD modifies outcomes after IVT and EVT, informing risk stratification and clinical decision-making in AIS. Conflict of interest George Kurian: nothing to disclose. Carlo Tamba: nothing to disclose. Muaamar Al-Gobari: nothing to disclose. Bianca Mazini: nothing to disclose. Jonas Richiardi: nothing to disclose. Gaia Sirimarco: nothing to disclose. Giulia Bommarito: nothing to disclose. Gilles Allali: nothing to disclose. Vincent Dunet: nothing to disclose. Davide Strambo: nothing to disclose. Patrik Michel: nothing to disclose.