Prognostic value of arterial calcification in acute ischemic stroke treated with endovascular thrombectomy: A systematic review and meta-analysis

Background Arterial calcification is commonly found in patients with cerebrovascular disease and may negatively affect outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). This systematic review and meta-analysis aimed to evaluate the impact of intracranial or aortic arch calcification on procedural success and functional outcomes in AIS patients undergoing anterior circulation EVT. Methods We systematically searched the PubMed, EMBASE, and Cochrane databases to identify studies comparing EVT outcomes between AIS patients with and without arterial calcification. Outcomes assessed included first-pass effect (FPE), successful reperfusion at the end of the procedure, modified Rankin scale (mRS), mortality, and symptomatic intracerebral hemorrhage (sICH). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random effects models, with heterogeneity evaluated with I 2 statistics. Results A total of six observational studies were included, with a total of 3834 patients (2303 with calcification and 1531 controls). Arterial calcification was associated with a lower chance of achieving FPE (RR: 0.50, 95% CI: 0.36–0.69, p < 0.001) and successful reperfusion (RR: 0.90, 95% CI: 0.86–0.94, p < 0.001). Patients with calcification had a greater risk of poor outcome (mRS 3–6) (RR: 1.29, 95% CI: 1.16–1.43, p < 0.001), mortality (RR: 1.51, 95% CI: 1.14–2.00, p < 0.001), and sICH (RR: 1.29, 95% CI: 1.16–1.43, p < 0.001). Heterogeneity was low, with I 2 ≤ 34%. Conclusion Arterial calcification may be indicative of advanced vascular disease, potentially leading to diminished technical success and worse functional outcomes following EVT for AIS. These findings underscore that vascular calcification acts as an associative marker of procedural complexity and advanced vascular disease in EVT candidates.