To systematically review randomized controlled trials and observational studies on the impact of endovascular thrombectomy (EVT) on cognitive outcomes in adults with acute ischemic stroke.
Key Findings:
EVT was associated with better cognitive outcomes compared to IVT or best medical therapy, with average score improvements of 1–4 points on MoCA or MMSE across 23 studies involving approximately 3,300 participants.
Executive functions showed the most consistent benefits, while memory effects were more variable.
Worse cognitive outcomes correlated with larger infarct volumes, gray-white matter involvement, and longer reperfusion times.
Post-stroke cognitive impairment remained common despite the benefits of EVT.
Interpretation:
Rapid EVT with successful reperfusion is linked to improved cognitive outcomes, particularly in global cognition and executive function, but cognitive deficits persist in many patients.
Limitations:
Substantial heterogeneity in cognitive assessment tools (e.g., MoCA, MMSE) and follow-up durations limited quantitative pooling of results.
Cognition was rarely a primary endpoint in EVT studies, leading to inconsistencies in findings.
Conclusion:
While EVT is associated with favorable cognitive outcomes, the prevalence of cognitive impairment post-stroke underscores the need for standardized assessments and longer follow-up in future studies.
