Mechanical Thrombectomy in Mild Acute Ischaemic Stroke with Large Vessel Occlusion: A Systematic Review [Protocol]

Background: Mechanical thrombectomy is established for acute ischaemic stroke due to large vessel occlusion, particularly in patients with moderate to severe neurological deficits. However, the benefit–risk profile in patients presenting with mild neurological deficits despite confirmed large vessel occlusion remains uncertain. Objective: To systematically synthesise evidence on the effectiveness and safety of mechanical thrombectomy compared with best medical therapy in adults with mild acute ischaemic stroke and large vessel occlusion. Methods: Randomised controlled trials and comparative observational studies will be included. Primary outcomes will include functional outcomes at 90 days, with secondary outcomes addressing safety, reperfusion, and early neurological deterioration. Meta-analysis will be performed using random-effects models where appropriate. Risk of bias and certainty of evidence will be assessed using Cochrane and GRADE methodologies. Registration: The systematic review protocol was prospectively submitted to PROSPERO with registration granted on the 6th of March, 2026 [CRD420261323013].