Impact of Intracranial Arterial Calcification on Outcomes of Mechanical Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Objective: Intracranial arterial calcification (ICAC) has been suggested to influence the outcomes of mechanical thrombectomy (MT) for acute ischemic stroke. We conducted a systematic review and meta-analysis to evaluate MT outcomes in patients with acute ischemic stroke and large-vessel occlusions involving intracranial calcified arteries. Methods: . Results: = 49%). In a subanalysis focusing on calcification volume, increased volume alone was not consistently associated with worse functional outcomes or lower reperfusion success (pooled OR ≈ 1.19; 95% CI 0.78-1.80). Collectively, the lack of association in the volume-based analysis and the significant association observed in studies incorporating intimal-medial differentiation suggest that lesion morphology-particularly the presence of intimal calcification-may exert a greater influence on MT outcomes than calcification volume itself. Conclusion: ICAC, especially when intimal calcification is present, is independently associated with procedural complexity and poor functional outcomes after thrombectomy for acute ischemic stroke. The divergent findings between the volume subanalysis and the broader morphology-based analysis highlight that morphology-driven, rather than volume-driven, calcification better explains outcome variability. Recognition of ICAC on baseline imaging may aid in prognostication, guide device strategies, and anticipate adjunctive interventions. Standardized assessments and prospective validation studies are needed to optimize outcomes.