ABSTRACT NUMBER: ESOC2026A2203 ENDOVASCULAR STROKE TREATMENT PERFORMED BY INTERVENTIONAL CARDIOLOGISTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Endovascular stroke therapy (EST) is a level 1A, time-critical intervention for acute ischemic stroke (AIS). Despite compelling evidence of benefit, worldwide access remains below 5% of eligible patients. Interventional cardiologists (ICs) have increasingly contributed to EST delivery and this systematic review and meta analysis aims to compare their results against guidelines. Methods We conducted a systematic review and meta-analysis following PRISMA guidelines. PubMed, OVID, and Cochrane were searched from inception to September 2024 and updated in October 2025. Eligible studies reported outcomes of EST performed by ICs. Randomised and non-randomised designs, observational cohorts, and case series were included; animal studies, conference abstracts, and non-English reports were excluded. Primary outcomes were successful reperfusion (mTICI ≥2b) and functional independence (mRS 0–2) at 90 days. Secondary outcomes included safety endpoints and procedural complications. Risk of bias was assessed with ROBINS-I or JBI tools. Results Twenty-eight studies comprising 1,846 patients were included. The pooled rate of successful reperfusion was 82.9% (95%CI 78.8-86.8) and functional independence at 90 days was 60.5% (95%CI 52.8–67.9). Safety outcomes were within guideline benchmarks: symptomatic intracranial haemorrhage 8.0% (95%CI 6.5-9.7), embolisation to new territory 3.4% (95%CI 2.2-4.9), and 90-day mortality 22.1% (95%CI 17.9-26.6). Conclusions ICs can deliver EST with outcomes within required standards. This collaborative model offers a pragmatic strategy to expand access to life-saving reperfusion, particularly in regions with limited neurointerventional capacity. Conflict of interest Work on behalf of ESC Council on Stroke. Individual authors have no conflicts of interests to disclose in relation to this work. The manuscript is under peer-review.