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Introduction Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large vessel occlusions. Conventional self-expanding stent retrievers (SE-SRs) deploy with fixed radial force, whereas Tigertriever is a radially adjustable operator-controlled device that allows tailored expansion and modulation of vessel wall pressure. This study systematically compared the efficacy and safety of Tigertriever with SE-SRs in large vessel occlusion thrombectomy.Methods A systematic search of PubMed, Cochrane, Embase, and ClinicalTrials.gov was conducted in line with PRISMA guidelines. Eligible studies compared Tigertriever with SE-SRs, with outcomes including rate of successful reperfusion (mTICI ≥2b), procedural adverse events (PAEs; composite of procedure-related vasospasm, dissection, perforation, distal emboli, emboli to new territory, and subarachnoid hemorrhage), symptomatic intracranial hemorrhage (sICH) within 24 hrs post-procedure, good functional outcome (mRS 0-2) at 90 days and all-cause mortality at 90 days. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using the Mantel-Haenszel method. Risk of bias was assessed using ROBINS-I, and certainty of evidence using the GRADE approach.Results Three retrospective cohort studies with 476 patients (210 Tigertriever, 266 SE-SR) were included. Target vessel occlusion locations were ICA, MCA M1, MCA M2 and basilar artery. Tigertriever achieved significantly higher successful reperfusion compared with SE-SRs [82.8% vs 77.8%; OR 1.74 (1.07-2.83); p=0.03; I 2=0%]. There was a trend towards less PAEs, but the difference did not reach statistical significance [17.1% vs 27.4%; OR 0.72 (0.44-1.16); p=0.17; I2=0%]. Rates of sICH within 24 hours, good functional outcomes at 90 days and mortality at 90 days were similar. The overall risk of bias was low to moderate. GRADE-assessed certainty for different outcomes was overall moderate.Conclusion Tigertriever was associated with significantly higher reperfusion rates, with a trend towards improved safety, and comparable functional outcomes. The absence of per-pass device use and reperfusion data presents a key limitation. Further prospective studies are warranted to validate these exploratory findings.Disclosures Z. Tariq: None. F. Shahzad: None. N. Jannat: None. S. Amin: None. Q. Bashir: None. M. AlMajali: None. J. Saver: None. A. Chaudhari: None.Abstract E-133 Figure 1