Abstract Number: Esoc2026a1433 Endovascular Treatment in Minor Acute Ischaemic Stroke Due to Large Vessel Occlusion: A Systematic Review and Meta-Analysis

Abstract Background and aims Endovascular therapy (EVT) is frequently performed in routine care for patients with acute ischaemic stroke (AIS) and minor symptoms (NIHSS6), despite scarce evidence supporting its safety and efficacy. This study aims to evaluate whether EVT with best medical treatment (BMT) provides clinical benefit compared to BMT-alone in patients with minor-AIS and large-vessel occlusion (LVO). Methods We performed a systematic search of MEDLINE, SCOPUS, and conference proceedings through January 3, 2026. Eligible studies included randomised or observational cohort studies enrolling patients with LVO-AIS and NIHSS6, comparing EVT with BMT-alone. Meta-analysis was performed using the random-effects model and calculating pooled odds ratios (ORs). Results Eighteen observational studies were included, comprising a total of 4,604 patients treated with EVT versus 5,675 patients treated with BMT alone. EVT was not associated with excellent functional outcome (mRS 0-1; OR: 1.12; 95%CI: 0.86-1.46; p=0.39; 17 studies), good functional outcome (mRS 0-2; OR: 1.02; 95%CI: 0.77-1.35; p=0.89; 16 studies) or reduced disability at 90 days (≥1-point mRS improvement; common OR: 0.81; 95%CI: 0.57-1.17; p=0.27; 7 studies). Symptomatic intracranial haemorrhage was more common in the patients receiving EVT (OR: 3.01; 95%CI: 2.03-4.46; p0.01; 14 studies). No association was observed between EVT and 90-day mortality (OR: 1.24; 95%CI: 0.86-1.79; p=0.25; 16 studies). Conclusions Pooled evidence from observational studies does not support EVT over BMT in patients with LVO-AIS and minor symptoms. Ongoing randomized-controlled clinical trials are needed to clarify the safety and efficacy of EVT in this population. Conflict of interest Nothing to disclose.