Mechanical Thrombectomy in the Management of Acute Ischemic Stroke Secondary to Calcified Cerebral Emboli: a Systematic Review

PURPOSE: Mechanical thrombectomy (MT), in combination with intravenous thrombolysis, have been widely accepted as effective therapies for acute ischemic stroke (AIS) secondary to large vessel occlusion. However, the presence of calcified cerebral emboli (CCE) has been associated with worse angiographic and clinical outcomes. Therefore, this systematic review aimed to evaluate the efficacy and safety of MT in the management of AIS secondary to CCE. METHODS: A systematic review was registered and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (CRD420251031539). PubMed, Ovid Medline, SCOPUS, The Cochrane Library and EMBASE were searched for publications until 13th April 2025. RESULTS: The search yielded 2102 publications. 14 studies met inclusion criteria (160 patients with AIS due to CCE). Two multi-centre studies reported recanalisation rates of only 57.5% and 57% respectively across 75 participants. Only 11.1-28.0% of patients in the included case series and cohort studies had a modified rankin score 2 at 3 months, suggesting that most patients did not regain functional independence following MT for CCE. MT for CCE was also associated with a 3-month mortality rate of 0-62.5%. Haemorrhagic complications were the most common adverse effect associated with MT. CONCLUSION: The available evidence from 14 studies elucidated poor recanalisation rates and functional outcomes when MT was used in the management of AIS secondary to CCE. However, the available evidence is primarily low-level evidence from observational studies, hence the conclusions should be interpreted with caution.