{
  "abstract": "Introduction Management of symptomatic carotid artery intraluminal thrombus (ILT) remains a challenge in neurovascular practice. Currently, there is a lack of high-quality data directly comparing the safety and efficacy of carotid endarterectomy (CEA), endovascular intervention (EVT), and medical management (MM). We performed a systematic review and proportional meta-analysis to evaluate pooled outcomes and identify the optimal management strategy for preventing ischemic recurrence and treatment failure in ILT patients.Methodology A systematic literature search was conducted across PubMed, Embase, and Scopus for studies published through December 2025. We included cohorts reporting outcomes for patients with ILT managed via CEA, EVT, or MM. The primary endpoints were ischemic complications and treatment success, which was defined as the absence of periprocedural complications and the need for secondary reintervention. Studies were excluded if they were case reports, included asymptomatic patients or focused on atherosclerotic plaques. Proportional meta-analyses were performed using a generalized linear mixed model with logit transformation to estimate pooled event rates. Meta-regression was employed to evaluate statistical differences in outcomes between the three management cohorts.Results The meta-analysis included a total of 582 patients. The pooled success rates were 0.95 (95%CI:0.84-0.98) for EVT, 0.83 (95%CI:0.77-0.89) for MM, and 0.79 (95%CI:0.62-0.90) for CEA. Meta-regression identified that EVT achieved significantly higher success rates compared to both MM (p=0.0421) and CEA (p=0.0183), while no significant difference was found between CEA and MM (p=0.6642). The pooled incidence of ischemic complications was 0.10 (95%CI:0.04-0.25) for EVT, 0.13 (95%CI:0.08-0.20) for MM, and 0.17 (95%CI:0.06-0.39) for CEA. Meta-regression revealed no statistically significant differences in ischemic complications between any treatment modalities (all p>0.05).Conclusion Endovascular intervention yields superior treatment success for symptomatic carotid ILT compared to MM or CEA. However, ischemic complication rates were similar across all modalities. These findings suggest EVT offers improved procedural reliability without altering ischemic risk.Disclosures S. Mendoza-Ayus: None. M. Cotroneo: None. E. Janiczek: None. T. Bhalla: None. M. Bender: None.Abstract E-288 Figure 1Abstract E-288 Figure 2",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Rochester, Rochester, NY"
      ],
      "name": "S Mendoza-Ayus"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester, Rochester, NY"
      ],
      "name": "M Cotroneo"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester, Rochester, NY"
      ],
      "name": "E Janiczek"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester, Rochester, NY"
      ],
      "name": "TK Mattingly"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Rochester, Rochester, NY"
      ],
      "name": "T Bhalla"
    },
    {
      "affiliations": [
        "University of Rochester, Rochester, NY"
      ],
      "name": "M Bender"
    }
  ],
  "title": "E-288 Superiority of endovascular intervention in the management of symptomatic carotid intraluminal thrombus: a meta-analysis",
  "uid": "4321f16f-e06a-5c79-8845-3590cf6cc9d6"
}