BACKGROUND: Aimed to compare the clinical efficacy and safety of endovascular thrombectomy (EVT) versus best medical therapy (BMT) in patients with progressive anterior circulation large vessel occlusion (LVO) stroke presenting beyond 24 hours from symptom onset. METHODS: Acute ischemic stroke patients who exhibited progressive neurological deterioration between 24 and 72 hours after symptom onset were retrospectively enrolled from 2020.02 to 2024.12. The primary outcome was functional independence at 90 days. Secondary outcomes included 90-day mortality and the incidence of symptomatic intracranial hemorrhage (sICH). RESULTS: A total of 190 patients were included (EVT: n=52; BMT: n=138). Baseline characteristics were well balanced. Compared with BMT, EVT was associated with a lower median 90-day mRS score (3IQR 2-4 vs 4IQR 3-6, OR=1.973, 95% CI 1.164-5.042, P=0.028), a higher rate of functional independence (46% vs 13%, OR=5.716, 95% CI 2.724-12.003, P<0.001), and a lower rate of severe disability or death (19% vs 50%, OR=0.247, 95% CI 0.113-0.529, P<0.001). Regarding safety, 90-day mortality was significantly lower in the EVT group (12% vs 41%, OR=0.182, 95% CI 0.074-0.469, P<0.001). The incidence of sICH was higher with EVT but did not reach statistical significance (10% vs 3%, OR=3.561, 95% CI 0.913-14.023; P=0.117). The between-group difference in outcome measures did not change substantially after matching. CONCLUSION: Among carefully selected patients with progressive anterior circulation LVO stroke presenting beyond 24 hours, EVT significantly improves functional outcomes and reduces mortality without significantly increasing the risk of sICH. These findings provide real-world evidence supporting individualized EVT decisions in extended time windows.
Dong et al. (Mon,) studied this question.