Background In acute ischemic stroke (AIS), intravenous thrombolysis (IVT) is standard, but some cases require surgical interventions after failed treatments. However, combining IVT or endovascular therapy with surgical embolectomy can increase hemorrhagic complications. Our meta-analysis assesses the use of surgical embolectomy post-unsuccessful thrombectomy in AIS patients.

Methods We conducted a literature search using PRISMA guidelines using Pubmed, Embase, Scopus, and Web of Science up to April 26, 2023. Statistical analysis was performed using R software to combine prevalence rates and their respective 95% confidence intervals (CI) using a random-fixed model. We evaluated outcomes such as the modified Rankin Scale (mRS - 0–2), successful recanalization and modified treatment in cerebral infarction (mTICI) score ≥2, symptomatic intracranial hemorrhage (sICH), and 90-day mortality.

Results Our analysis showed that the use of surgical intervention resulted in 48.15% (95% CI: 30.39–66.39) 90-day favorable outcome with (95% CI: 50.70–99.91) successful recanalization rate (mTICI >2) and sICH of 1.84% (95% CI: 0.03–57.30), and mortality rate of 12.31% (95% CI: 3.22–37.19) at 90 days.

Conclusion Our analysis shows that surgical embolectomy may be considered a treatment option in stroke patients who failed thrombectomy.

Disclosures M. Pakkam: None. A. Orscelik: None. B. Musmar: None. Y. Senol: None. S. Ghozy: None. C. Bilgin: None. R. Kadirvel: None. D. Kallmes: None.