ABSTRACT NUMBER: ESOC2026A1799 BRIDGING VERSUS DIRECT THROMBECTOMY IN MEDIUM VESSEL OCCLUSION STROKE. A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Medium vessel occlusions (MeVOs) represent nearly 30% of acute ischemic strokes, yet optimal management remains uncertain. These strokes often present with milder deficits, distal occlusions, and smaller clot burdens, suggesting potential benefit for intravenous thrombolysis (IVT) as an adjunct to mechanical thrombectomy (MT). This study compares outcomes between bridging therapy (IVT plus MT) and direct MT in MeVO-related stroke. Methods A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted from inception to December 2025. Studies comparing bridging therapy versus direct MT in MeVO-related stroke patients were included. Efficacy outcomes included a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days, and successful recanalization. Safety outcomes comprised all-cause mortality and intracranial hemorrhage (ICH). Pooled estimates were calculated using random-effects models. Results Three comparative studies including 1,001 patients were included. No significant differences were observed between the two groups in favorable functional outcomes (mRS 0–2) at 90 days (OR 1.99, 95% CI 0.58–6.80; p = 0.27) or in rates of successful recanalization (OR 1.69, 95% CI 0.76–3.74; p = 0.20). Similarly, the incidence of ICH and all-cause mortality did not differ significantly between groups (OR 1.29, 95% CI 0.77–2.18; p = 0.34; and OR 0.81, 95% CI 0.45–1.45; p = 0.48, respectively). Conclusions In MeVO-related stroke, bridging therapy offered no significant advantage over direct thrombectomy in functional outcomes, recanalization, safety, or mortality, suggesting direct MT alone may be sufficient. larger randomized trials are needed to confirm these findings. Conflict of interest Rashad G. Mohamed.nothing to disclose Amir Hegazi.nothing to disclose Mohamed Ehab Eldesoky.nothing to disclose Khalid sarhan.nothing to disclose Magdy shehab.nothing to disclose Mostafa Meshref.nothing to disclose