Abstract 158: Association between thrombus characteristics and endovascular therapy outcome in stroke: a systematic review and meta‐analysis

Introduction Background: Prediction of successful revascularization and achieving a favorable functional outcome may help to determine the optimal recanalization strategy and improve the management of stroke. A growing body of literature has implicated a prognostic value for thrombus imaging characteristics for stroke outcomes [1‐5]. Methods We conducted an electronic search using PubMed, Ovid MEDLINE, and EMBASE, previously published meta‐analyses, and systematic review studies that intervened by endovascular thrombectomy (EVT) or intravenous thrombolysis (IVT) following large vessel occlusion stroke from 2000‐2023 and involved MR‐based thrombus imaging, then screened 2007 studies against our eligibility criteria. We extracted the enrollees’ characteristics and the association between clot features and radiological and functional outcome measures. Results Thirty‐three studies were found eligible, with a total number of 6902 enrollees. Susceptibility Vessel Sign (SVS) was reported in 3531 subjects (51.2%). Nine studies only involved the administration of IVT, while 24 studies intervened by EVT. Seventeen studies found at least an association between a thrombus imaging characteristic and successful recanalization while the others reported no association. On the other hand, only thirteen studies found at least an association between thrombus characteristics and functional outcome, while the rest thrombus characteristics showed no association with functional outcome. Pooled meta‐analysis of studies that involved EVT with or without preceding IVT showed a statistically significant association between the presence of SVS and both successful recanalization (RR: 1.57 [1.09 – 2.27]; P: 0.02) and favorable functional outcome (RR: 1.76 [1.17 – 2.66]; P: 0.007). Conclusion The presence of SVS on MR‐based clot imaging was associated with functional outcome and successful recanalization following thrombectomy.