Objective:

To evaluate the outcomes, and safety of Mechanical Thrombectomy performed by interventional cardiologists compared to neurointerventional specialists 

Background:

Only 3–5% of patients with acute ischemic stroke receive Mechanical Thrombectomy (MT) in the US. Interventional cardiologists have catheter-based skills similar to that required for MT and could help address workforce shortages. 

Design/Methods:

A systematic review and meta-analysis were conducted per PRISMA guidelines and registered with PROSPERO. PubMed and Embase were searched for studies published between January 2000 to July 2025 for MT performed by interventional cardiologists in acute ischemic stroke due to Large Vessel Occlusion (LVO). Inclusion required study design that was either a randomized controlled trial or a non-randomized prospective or retrospective observational study, reporting of recanalization, NIHSS change, functional outcomes, ICH, or mortality. 

Results:

The 12 studies included in this review were conducted across five enrolling over 1,100 patients with mean patient age in 60-70s and median/mean NIHSS scores of 15-18. Majority of cases involved anterior circulation. Procedural efficiency was notable, with cardiologist led MT achieving puncture-to-recanalization times of 25-40 minutes, meeting the recommended benchmark of ≤60 minutes in at least 70% of cases. Recanalization rates for cardiologist performed MT were high, with TICI 2b/3 achieved in 72-93% of cases, closely aligning with HERMES (71%) and ASTER2 (85.6%). Functional outcomes were also comparable, with 40-61% of patients treated by cardiologists achieving functional independence (mRS ≤2) at 90 days, similar to HERMES meta-analysis (46%) and large registries (40-54%). Mortality rates at 90 days for cardiologist led MT ranged from 13% to 35%, similar to neurointerventional trials (14.9-16.1%) and real-world registries (25-35%). Symptomatic intracranial hemorrhage rates for cardiologist-performed MT were generally between 4% and 15%, comparable to neurointerventional benchmarks trials reporting rates of 4-8%. 

Conclusions:

MT performed by interventional cardiologists is feasible and effective within multidisciplinary teams, with outcomes comparable to neurointerventionalists.