Key Points Question What are the prevalence and extent of small study effects in the diagnostic imaging literature? Findings This meta-analysis of diagnostic performance data pooled from 31 diagnostic imaging accuracy meta-analyses including 668 primary studies found significant evidence for small study effects. Subgroup analysis by imaging modality revealed similar trends throughout all examined modalities (computed tomography, magnetic resonance imaging, positron emission tomography, ultrasonography). Meaning These findings suggest small study effects are widely underestimated at the level of individual meta-analyses when using conventional methods, including visual assessment of funnel plots and Egger test.

Introduction Acute ischemic stroke (AIS) can be a catastrophic complication of cardiac surgery previously without effective treatment. Endovascular thrombectomy (EVT) is a potentially life‐saving intervention. We examined patients at our institution who had EVT to treat AIS post cardiac surgery. Methods We retrospectively reviewed a stroke database from January 1, 2016 to October 31, 2021 to identify patients who had undergone EVT to treat AIS following cardiac surgery. Demographic data, operation type, stroke severity, imaging features, management and outcomes (mortality and modified Rankin Score (mRS)) were assessed. Results Of 5022 consecutive patients with AIS, 870 underwent EVT. Seven patients (0.8%) had EVT following cardiac surgery. Operations varied: two coronary artery bypass grafting (CABG), two transcatheter AVR, one redo surgical aortic valve replacement (AVR), one mitral valve repair and one patient with combined aortic and mitral valve replacements and CABG. Meantime postsurgery to stroke symptoms onset was 3 days (range 0–9 days). Median NIHSS was 26 (range 10–32). Five patients had middle cerebral artery occlusion and two internal carotid artery (n = 2). Median time between onset of symptoms and recanalization was 157 min (range 97–263). Two patients received Intra‐arterial Thrombolysis. All patients survived and were discharged to another hospital (n = 3), home (n = 2), or rehabilitation facility (n = 2). Median 3‐month mRS was 3 (range 0–6). Conclusion We report the largest case series of EVT after cardiac surgery. EVT can be associated with excellent outcomes in these patients. Close neurological monitoring postoperatively to identify patients who may benefit from intervention is key.

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