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Disclosure of interest: No ESOC 2023 – Moderated Posters ACUTE MANAGEMENT DAY 1 16 Distal Medium Vessel Occlusions in Acute Ischaemic Stroke: Stent Retriever versus Direct Aspiration - A Systematic Review and Meta-Analysis Ming Yi Koh* 1 , Keith Zhi Xian Toh 1 , Enver De Wei Loh 1 , Gabriel Yi Ren Kwok 2 , Yao-Hao Teo 3 , Yao-Neng Teo 3 , Claire Xin Yi Goh 3 , Nicholas LI-Xun Syn 4 , Andrew Fu-Wah Ho 5,6 , Ching-Hui Sia 3,7 , Patrick Brouwer 8 , Tommy Andersson 9 , Lukas Meyer 10 , Jens Fiehler 10 , Pervinder Bhogal 11 , Vijay K Sharma 3,12 , Benjamin Tan 3,12 , Leonard Yeo 3,12 1 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, Singapore , 2 Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom , 3 Yong Loo Lin School of Medicine, National University of Singapore, Department of Medicine, Singapore, Singapore , 4 University Surgical Cluster, National University Health System, Singapore, Department of Surgery, Singapore, Singapore , 5 SingHealth Duke-NUS, Emergency Medicine Academic Clinical Program, Singapore, Singapore , 6 Duke-National University of Singapore Medical School, Cardiovascular and Metabolic Disorders Program, Singapore, Singapore , 7 National University Heart Centre Singapore, Department of Cardiology, Singapore, Singapore , 8 Cerenovus (Johnson & Johnson), Galway Neuro Technology Centre, -, Galway, Ireland , 9 Karolinska University Hospital, -, Stockholm, Sweden , 10 University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg, Germany , 11 The Royal Hospital, London, Interventional Neuroradiology, London, United Kingdom , 12 National University Hospital, Singapore, Division of Neurology, Department of Medicine, Singapore, Singapore Background and aims: Acute ischaemic stroke due to distal medium vessel occlusion (AIS-DMVO) causes significant morbidity