Safety and clinical outcomes of mechanical thrombectomy for acute stroke in pregnant patients: A systematic review

Abstract

Mechanical thrombectomy (MT) is an established and guideline-endorsed treatment for acute ischemic stroke (AIS) due to large vessel occlusion. Intravenous thrombolysis (IVT) with alteplase remains the first-line therapy within the approved time window, often used alone or as a bridging strategy before MT. However, both interventions have been systematically understudied in pregnant patients, as this population has been excluded from most pivotal clinical trials. This systematic review critically evaluates the procedural feasibility, safety, and maternal-fetal outcomes of MT in pregnant patients experiencing AIS. A comprehensive literature search using PubMed, Embase, and Web of Science yielded 16 studies encompassing 26 cases. In 20 of these, the occlusions involved the M1 segment of the middle cerebral artery, with 58% receiving combined IVT and MT, and 42% undergoing MT alone. Successful reperfusion (TICI 2b-3) was attained in 84% of cases. The median times were 120 min from onset to hospital arrival, 92 min from arrival to puncture, and 330 min from onset to recanalization. Favorable maternal outcomes (mRS 0-1) were observed in 91% of cases at follow-up, and no direct MT-related fetal mortalities occurred. Radiological protection practices, though inconsistently reported, commonly included abdominal shielding and optimized fluoroscopic protocols. Despite limited high-level evidence, MT in pregnancy appears technically feasible and clinically beneficial, warranting prompt multidisciplinary coordination and robust imaging protocols. Future prospective research is essential to better define safety parameters and optimize guidelines for this vulnerable subgroup of patients.