Relationship between early venous filling after thrombectomy and intracranial hemorrhage and prognosis in patients with acute ischemic stroke: a systematic review and meta-analysis

Objective This study aims to assess the relationship between early venous filling (EVF) observed during mechanical thrombectomy and 90-day functional independence (mRS ≤ 2) as well as postoperative intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (SICH), in patients with acute ischemic stroke. Methods We conducted a systematic search of the PubMed, EMBASE, Web of Science, and Cochrane Library databases up to September 26, 2024, following the PRISMA 2020 guidelines. The primary clinical outcomes were defined as 90-day functional independence (mRS ≤ 2) and SICH, while the secondary clinical outcome was ICH. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using a random-effects model. Results A total of six studies that met the inclusion criteria were analyzed. Meta-analysis demonstrated that patients with EVF had a significantly reduced likelihood of achieving 90-day functional independence compared to patients without EVF (OR 0.42, 95% CI 0.18–0.99, P = 0.05). Moreover, patients with EVF exhibited a markedly higher risk of post-procedural SICH than patients without EVF (OR 4.68, 95% CI 2.20–9.96, P < 0.001). Additionally, EVF was strongly linked to an increased incidence of post-procedural ICH (OR 5.73, 95% CI 2.57–12.82, P < 0.0001). Conclusion EVF may serve as an intraoperative angiographic marker associated with a higher incidence of postoperative ICH, SICH, and poorer 90-day functional independence. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42024595410.