While stroke incidence has declined in the general population, maternal stroke rates are rising, posing a growing clinical concern. Due to the rarity of cases and challenges in conducting research among pregnant women, high-quality evidence to guide management remains limited.

A systematic literature search was conducted using PubMed, EMBASE, and Google Scholar to identify studies on EVT in pregnant patients with ischemic stroke. Data extracted included patient demographics, stroke characteristics, assessments and EVT details (devices, access, timing, TICI scores). Maternal outcomes included mortality, modified Rankin scale, hemorrhagic and thromboembolic complications. Fetal and obstretic outcomes included fetal/neonatal mortality, delivery mode, neonatal indicators, and long-term neurodevelopmental data.

Fifteen studies involving 25 pregnant patients were included. The mean age was 31.6 years, with ESUS being the most common stroke etiology. Thrombolysis was administered in 48% of cases. Stent retrievers were the most frequently used devices, and middle cerebral artery occlusion was observed in 88% of patients. Complete reperfusion (TICI 3) was achieved in 39.1% of cases. No maternal deaths were reported. Hemorrhagic complications occurred only in the third trimester. Most patients showed functional neurological recovery (mRS 0–2). Delivery outcomes were documented in 17 cases, with 41.2% undergoing cesarean section. Approximately 70–80% of pregnancies resulted in successful deliveries, while fetal losses occurred in 20–30% of cases. Long-term neurodevelopmental outcomes were generally favorable.

Thrombectomy during pregnancy appears to be safe and effective, particularly in the second and third trimesters. However, fetal risks may be higher in the first trimester. This may be due to greater placental and hemodynamic stability after the end of organogenesis and reduced fetal vulnerability. Prospective studies with detailed outcome reporting are key to guiding clinical protocols.