Efficacy and safety of edaravone dexborneol in acute ischemic stroke patients undergoing endovascular thrombectomy: a systematic review and meta-analysis.

Acute ischemic stroke (AIS) causes disability. Edaravone-dexborneol (ED) acts through antioxidant and anti-inflammatory mechanisms. This meta-analysis evaluated ED as an adjunct to endovascular thrombectomy (EVT). Databases were searched through July 2026 for studies comparing ED with control in AIS patients undergoing EVT. The primary outcome was 90-day functional independence (mRS 0-2). Hartung-Knapp random-effects models, RoB 2, ROBINS-I, and GRADE were used. Eight studies (4 RCTs and 4 observational studies; n = 5101) were included. However, the number of participants contributing to each pooled analysis varied according to outcome availability. Notably, all eight included studies were conducted exclusively in China. Five studies involving 2057 patients contributed to the primary outcome analysis. The overall pooled analysis failed to show a statistically significant improvement in functional independence (RR 1.26; 95% CI 0.90-1.77), indicating substantial uncertainty in the combined evidence. RCTs showed improved functional independence (RR 1.11; 95% CI 1.04-1.19) and reduced hemorrhagic transformation (RR 0.55; 95% CI 0.46-0.66). Other outcomes showed no significant differences. Current evidence does not demonstrate a statistically significant overall benefit of ED on functional independence, though a modest improvement was observed in randomized trials alone. While ED was associated with reduced hemorrhagic transformation without an increase in major safety events, these results are derived exclusively from Chinese cohorts and are limited by unadjusted observational data. These findings must be interpreted with caution, and larger, multi-national randomized trials are required to determine true efficacy and global applicability.