Abstract Number: Esoc2026a174 Impact of Delayed Endovascular Thrombectomy Beyond Eight Hours on Clinical Outcomes in Acute Ischemic Stroke: A Real-World Single-Center Study

Abstract Background and aims Endovascular thrombectomy (EVT) is the standard treatment for large-vessel occlusion. After national policy expansion in Taiwan allowing EVT up to 24 hours, real-world uncertainties remain regarding delays, hemorrhagic risk, and functional outcomes. This study examined the clinical impact and prognostic factors associated with extended-window EVT. Methods In this retrospective study, 352 acute ischemic stroke patients treated between November 2023 and June 2024 at a stroke center in a medical center in Taiwan were analyzed. Patients receiving IV thrombolysis (IVT), EVT, or bridging therapy within 24 hours were included. Outcomes were classified as good (mRS 0–3) or poor (mRS 4–6). Logistic regression evaluated predictors of poor outcome. Results Among EVT recipients, 56.4% had poor outcomes. Independent predictors included older age (aOR 1.032; p=0.010), higher NIHSS (aOR 1.078; p=0.003), post-EVT intracranial hemorrhage (aOR 3.542; p0.001), and delayed EVT 8 hours (aOR 4.583; p=0.002). Patients treated beyond eight hours had significantly worse functional outcomes. IVT patients showed better outcomes but had milder deficits. Hemorrhagic complications, especially symptomatic ICH, were strongly associated with poor prognosis. Conclusions Despite a 24-hour treatment window, time-to-treatment remains critical. EVT beyond eight hours markedly increases the risk of poor outcomes and bleeding. Streamlined workflows, rapid neurologic assessment, and vigilant post-EVT monitoring—particularly by advanced practice stroke nurses—are essential to optimize the safety and effectiveness of extended-window EVT. Conflict of interest YING-YING Huang. nothing to disclose