Impact of Distal Embolization on Endovascular Treatment Outcomes in Acute Ischemic Stroke

Background Endovascular thrombectomy is standard for large‐vessel occlusion stroke, but distal embolization is common and may diminish benefits with mixed evidence on its clinical impact. Given heterogeneous methods and findings across studies, a meta‐analysis is warranted to quantify how distal embolization affects the outcomes. Methods A comprehensive literature search was conducted across various databases until June 2025 to identify relevant studies assessing the outcomes after distal embolization. The quality was assessed using the New Castle Ottawa tool and the analysis was performed using RevMan 5 software. Results Distal embolization during mechanical thrombectomy was not associated with higher odds of 90‐day functional independence (mRS 0‐2) (OR 0.64, P = 0.06) or with 90‐day mortality (OR 1.16; P = 0.61). Symptomatic intracranial hemorrhage rates were also similar between groups (OR 1.38, P = 0.34). In contrast, distal embolization was associated with greater worsening in NIHSS from baseline to discharge (MD 5.58; P = 0.004; I 2 = 26%) and lower odds of successful reperfusion (OR 0.42; P < 0.0001; I 2 = 27%). Conclusion Distal embolization during mechanical thrombectomy does not appear to alter 90‐day functional independence, mortality, or symptomatic intracranial hemorrhage, but it is associated with lower rates of successful reperfusion and worse early neurological status at discharge. These findings suggest that distal embolization chiefly undermines immediate procedural and short‐term clinical outcomes, highlighting the need to refine techniques and devices to minimize its occurrence.