Edaravone dexborneol for acute ischaemic stroke among patients undergoing endovascular treatment: a systematic review and meta-analysis

BACKGROUND: Acute ischaemic stroke (AIS) remains a major cause of disability and mortality worldwide. Endovascular treatment (EVT) is the standard of care for large vessel occlusion, yet a favourable neurological outcome is not achieved in all patients. Edaravone dexborneol (ED) has been proposed as an adjuvant therapy during EVT procedures. However, its clinical impact has not been systematically synthesized. METHODS: This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. PubMed, Web of Science, Scopus, ClinicalTrials.gov, Cochrane Central, and Embase were searched from inception to March 2026. Randomized and non-randomized studies comparing ED versus non-ED (placebo) controls in AIS patients undergoing mechanical thrombectomy (MT) were included. The primary outcomes of this study were excellent and good neurological outcomes at 90 days, measured with the modified Rankin Scale. A random-effects meta-analysis was performed, with robust sensitivity analyses to explore heterogeneity. RESULTS: Seven studies were included, of which three were randomized. For the primary outcomes, there was no significant difference in the proportion of patients with excellent (mRS 0-1: OR 1.14; 95% CI 0.95 to 1.36; p = 0.17) or good neurological outcome (mRS 0-2: OR 1.34; 95% CI 0.97 to 1.85; p = 0.08). The incidence of symptomatic intracranial hemorrhage (sICH) was similar between groups (OR 0.73; 95% CI 0.50 to 1.07; p = 0.11). Prediction intervals crossed the null for all efficacy outcomes. No significant differences were observed in mortality at 90 days (p = 0.51). However, in pooled adjusted analyses, ED was associated with a modest increase in good neurological outcome (aOR 1.46; 95% CI 1.13 to 1.90; p = 0.004). CONCLUSION: Unadjusted analyses show no significant benefit of ED in reducing mortality, symptomatic bleeding events, or improving functional recovery. However, pooled adjusted estimates suggest a modest improvement in good neurological outcomes (mRS 0-2). Wide prediction intervals crossing the null indicate that the current evidence is preliminary, and confirmation in adequately powered trials is needed before routine clinical adoption.