Background The Susceptibility Vessel Sign (SVS) on MRI has been linked to functional outcomes and reperfusion success after endovascular treatment (EVT). This updated meta‐analysis aimed to evaluate the prognostic value of SVS in acute ischemic stroke (AIS). Methods We conducted a systematic search of PubMed, Embase and Cochrane in May 2025. Eligible studies included post‐hoc analyses of randomized controlled trials (RCTs) and observational studies of AIS patients treated with EVT and/or intravenous thrombolysis (IVT). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random‐effects model. Primary outcome was successful reperfusion (mTICI 2b‐3). Secondary outcomes included functional independence (modified Rankin Scale mRS score 0‐2), mortality, stroke etiology, and time metrics. Results Twenty studies (n = 2,878) were included. SVS was not associated with higher reperfusion (RR: 1.01; 95% CI: 0.93‐1.10; p = 0.832; I 2 = 56.0%), but it was linked to lower 90‐day mortality in anterior circulation strokes (RR 0.52; 95% CI 0.36‐0.74; p < 0.001; I 2 = 0%), improved 90‐days functional independence in Western populations (RR: 1.22; 95% CI: 1.01‐1.47, p = 0.039; I 2 = 37.7%), and with cardioembolic stroke etiology using GRE (RR 1.29; 95% CI 1.05‐1.57; p=0.014; I 2 =36.3%). The mean time from onset to treatment was 238.19 minutes ± 147.5. Conclusions Although SVS⁺ did not predict reperfusion, it was associated with better outcomes in Western populations, cardioembolic stroke, and lower mortality, reinforcing its prognostic value. MRI protocols did not delay treatment, but high heterogeneity limits certainty, highlighting the need for prospective validation. image image
Tran et al. (Sat,) studied this question.