Prospective cohort study demonstrates rescue thrombectomy improves functional recovery in delayed stroke deterioration, suggesting benefit beyond standard intervention windows.
Key Points
To evaluate whether rescue mechanical thrombectomy improves 90-day clinical outcomes in patients with anterior circulation large-vessel occlusion who develop early neurological deterioration beyond the standard treatment window.
Prospective observational study enrolling patients with anterior circulation large-vessel occlusion and initial mild deficits (NIHSS score 1–5) who experienced early neurological deterioration between 24 and 72 hours post-stroke onset.
Eligible patients were evaluated by a multidisciplinary team and treated with either rescue mechanical thrombectomy (n=121) or best medical management (n=59), with 180 of 187 completing 90-day follow-up.
Rescue mechanical thrombectomy significantly improved 90-day functional independence (mRS 0–2) compared with medical management: 37.2% (45/121) vs 20.3% (12/59) (adjusted risk ratio [aRR] 1.97, 95% CI 1.01 to 3.82, p=0.044).
Thrombectomy was associated with reduced 90-day all-cause mortality (aRR 0.49, 95% CI 0.24 to 0.99, p=0.048) and increased favorable outcome rates (mRS 0–3: aRR 2.09, 95% CI 1.38 to 3.18, p=0.001).