Cognitive outcomes after endovascular thrombectomy in ischemic stroke: a systematic review

Balcerzak, Wiktoria; Początek, Gabriela; Lasek-Bal, Anetta; Gorzkowska, Agnieszka · 2026 · Crossref

DOI: 10.3389/fmed.2026.1787129

archive: archived pipeline: cataloged verified

Get this paper ↗ (DOI — opens at the source; we link to it, we don't host it)

Summary

This systematic review addresses the uncertainty surrounding the cognitive impact of endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to large-vessel occlusion. While EVT is established as the standard treatment for improving functional independence, its specific effects on cognition remain less clearly defined despite the high prevalence of post-stroke cognitive impairment. The authors aimed to synthesize current evidence to compare EVT against intravenous thrombolysis (IVT) or best medical therapy, identify affected cognitive domains, and examine clinical and biological predictors of recovery. Following PRISMA 2020 guidelines, the authors conducted a systematic search of PubMed, Embase, the Cochrane Library, and Scopus for studies published between January 2015 and October 2025. Eligible studies included randomized controlled trials and observational studies reporting objectively measured cognitive outcomes in adults. Due to substantial heterogeneity in assessment tools, outcome definitions, and follow-up durations, quantitative meta-analysis was not feasible; findings were synthesized narratively. Risk of bias was assessed using RoB 2 and the Newcastle–Ottawa Scale, and evidence certainty was graded using GRADE. The review included 23 studies involving approximately 3,300 participants. Across most comparative studies, EVT was associated with better cognitive outcomes than IVT or best medical therapy, typically yielding 1–4 point higher scores on the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE) at early to mid-term follow-up. Executive function showed the most consistent benefit, with more variable but favorable effects on memory. Worse cognitive outcomes were linked to larger infarct volume, combined gray–white matter involvement, territorial infarct patterns, and longer time to reperfusion. Exploratory proteomic analyses suggested associations between inflammatory and neurotrophic markers and cognitive recovery. Despite these benefits, post-stroke cognitive impairment remained frequent. The certainty of evidence was generally low to very low, primarily due to reliance on observational designs, heterogeneity, and limited long-term data. The authors conclude that EVT, particularly when performed rapidly with successful reperfusion, is associated with more favorable cognitive outcomes, especially in global cognition and executive function. However, persistent cognitive deficits remain common, highlighting the need for standardized cognitive assessment and longer-term follow-up in future EVT studies. The findings suggest that while EVT offers cognitive advantages over medical therapy alone, further research is required to fully characterize long-term trajectories and optimize strategies for cognitive preservation.

Provenance

The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed.

Summary generated by qwen3.6-27b-prismaquant on 2026-06-26; verification: verified.

Topics

Ranked by relevance to this paper. Hover a topic for its definition.

• cognitive impairment