Abstract TP312: Outcomes of Endovascular Therapy in Calcified Cerebral Emboli in Acute Ischemic Stroke: A Systematic Review and Meta

Background: Endovascular therapy (EVT) has become the standard of care for acute ischemic stroke due to large vessel occlusion. However, outcomes vary considerably depending on the characteristics of the embolus. Calcified cerebral emboli (CCE) pose unique challenges during EVT, including lower rates of successful recanalization, resistance to thrombus retrieval, and a potentially higher risk of complications. A systematic synthesis of EVT outcomes in patients with CCE is essential to define their prognostic implications better and guide individualized stroke management. Objective: To systematically review and synthesize available evidence on clinical and angiographic outcomes following EVT in patients with acute ischemic stroke caused by calcified cerebral emboli. Methods: A systematic literature search identified studies reporting EVT outcomes in patients with CCE. Data were extracted on recanalization success, thrombus resolution, intracranial hemorrhage, and modified Rankin Scale outcomes at follow-up. Meta-analytic pooling was performed where possible, and forest plots were generated to summarize findings. Between-study heterogeneity was explored descriptively. Results: Five studies encompassing 138 patients were included. Successful reperfusion (mTICI ≥2b) was achieved in 44–58% of cases, while functional independence (mRS ≤2 at 90 days) was reported in 26–29% of patients. Hemorrhagic complications ranged from 0% to 23%, and 90-day mortality was as high as 56% in some cohorts. Thrombus resolution was inconsistently reported, with limited comparative data available