To assess the safety and efficacy of Endovascular Thrombectomy (EVT) in adults with posterior circulation acute ischemic stroke (PCAIS) in Latin America.

Recent studies have demonstrated better functional outcomes for EVT in patients with PCAIS. However, there is scarcity of data in Latin America, a region with its own socio demographic and health-related characteristics and with patients who tend to have a poorer prognosis after a stroke.

A systematic search was performed in PubMed, Embase, SCOPUS, WOS, Lilacs and Scielo for studies conducted up to September 2023. Studies aiming to assess the safety and efficacy of EVT in Latin American adults with PCAIS were selected. Outcomes of interest included functional independence (90-day mRS 0-3), symptomatic intracerebral hemorrhage (sICH), and all-cause mortality at 90 days. Quality assessment was performed using Cochrane Risk of bias 2 tool and NewCastle-Ottawa for observational studies. A single-arm and a random effects model meta-analysis of proportions were conducted, using the I² statistics to measure the statistical heterogeneity.

A total of 2557 studies were screened, and ten studies were selected, representing a total of 224 patients with PCAIS. All of them were observational studies. Bridging with Intravenous thrombolysis was reported in most studies. The pool proportion of patients with functional independence was 36% CI 95% [29%, 45%]; Pooled proportions for mortality and sICH were 8% CI 95% [4%,15%] and 38% CI 95% [30%,46%], respectively. Only two studies reported EVT vs other treatments (n=24), showing a pooled OR of 2.17 CI 95% [0.96; 4.91]. Quality assessment showed low to medium risk of bias.

Our findings show similar efficacy to other studies; however, mortality and sICH appear to be higher. EVT could be a promising technique for PCAIS, however randomized controlled trials are needed to adequately evaluate the outcomes of EVT vs standard of treatment in Latin America.