Abstract Number: Esoc2026lb71 Technique Selection in Mechanical Thrombectomy for Acute Large Vessel Occlusion , a Systematic Review and Meta-Analysis

Background and aims INTRODUCTION Acute ischemic stroke from large vessel occlusion remains a major cause of mortality and disability. Despite mechanical thrombectomy as standard care, technique selection varies widely. Optimizing first-pass reperfusion while minimizing distal embolization is critical, yet no standardized evidence-based framework currently guides procedural choice. OBJECTIVES 1. Systematically evaluate evidence comparing mechanical thrombectomy techniques. 2. Assess the impact of technique selection on: • Reperfusion success • Safety outcomes • All-cause mortality 3. Inform a patient-specific, evidence-based approach to technique selection in interventional neuroradiology. Methods METHODOLOGY Systematic review and meta-analysis of adults with acute large vessel occlusion stroke comparing aspiration-first, stent retriever–first, combined techniques, and balloon guide catheter use. Outcomes included reperfusion success, first-pass effect, 90-day functional independence, mortality, and procedural complications, analyzed using random-effects risk ratios with 95% confidence intervals. Results Stent retriever (SR) & ADAPT High reperfusion (~79–86%) and good functional outcomes (~45–52%); SR has modest first-pass effect (~24%) and ~8% sICH. •Combined SR + aspiration / BGC: Improves first-pass and final reperfusion (~88%) and functional independence; BGC reduces mortality. •Meta-analysis: No difference in all-cause mortality (RR 0.89) or adverse events (RR 1.00); adjunctive/combined techniques increase reperfusion success (RR 1.09), evidence low–moderate. Conclusions Mechanical thrombectomy technique selection significantly affects reperfusion efficiency without altering overall mortality or safety outcomes. Stent retriever and aspiration-first approaches are equivalent first-line strategies, while combined techniques and balloon guide catheter use enhance reperfusion quality in selected patients. An individualized, anatomy- and clot-based approach is essential to optimize outcomes in interventional stroke therapy. Conflict of interest