Of the 321 identified studies, 16 met the inclusion criteria, comprising 3,879 patients. Fourteen studies focused exclusively on the anterior circulation, one on the posterior circulation, and one examined both circulations. Vessel tortuosity significantly impacted thrombectomy success, with lower recanalization rates, particularly when aspiration techniques were employed. The absolute difference in recanalization success rates ranged between 29% and 55% in the anterior circulation, comparing highly tortuous vessels to less tortuous ones. The internal carotid artery (ICA) and middle cerebral artery (MCA) were the most frequently occluded vessels, both of which are especially prone to tortuosity, adding procedural complexity. While some studies reported increased hemorrhagic complications in highly tortuous vessels, findings were inconsistent. Data on functional recovery were limited, preventing definitive conclusions about the influence of tortuosity on long-term outcomes.