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Case series
Endovascular treatment beyond 24 hours from the onset of acute ischemic stroke: the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS)
  1. Ilaria Casetta1,
  2. Enrico Fainardi2,
  3. Giovanni Pracucci3,
  4. Valentina Saia4,
  5. Stefano Vallone5,
  6. Andrea Zini6,
  7. Mauro Bergui7,
  8. Paolo Cerrato8,
  9. Sergio Nappini9,
  10. Patrizia Nencini10,
  11. Roberto Gasparotti11,
  12. Andrea Saletti12,
  13. Francesco Causin13,
  14. Daniele Romano14,
  15. Nicola Burdi15,
  16. Andrea Giorgianni16,
  17. Salvatore Mangiafico17,
  18. Danilo Toni18
  19. The Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS)
  1. 1 Neurology, Università degli Studi di Ferrara, Ferrara, Italy
  2. 2 Neuroradiology, Università degli Studi di Firenze, Firenze, Italy
  3. 3 Neurology, University Hospital Careggi, Firenze, Italy
  4. 4 Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
  5. 5 Neuroradiologia, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
  6. 6 Neurology and Stroke Center, Maggiore Hospital, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
  7. 7 Interventional Neuroradiology, Università degli Studi di Torino, Torino, Italy
  8. 8 Neurology: Stroke Unit, Ospedale “Molinette”, Stroke Unit, Torino, Italy
  9. 9 Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy
  10. 10 Neurology, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
  11. 11 Neuroradiology, Università degli Studi di Brescia, Brescia, Italy
  12. 12 Neuroradiology, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Ferrara, Italy
  13. 13 UOC Neuroradiologia, Azienda Ospedaliera di Padova, Padova, Italy
  14. 14 Neurordiology, University Hospital 'San Giovanni di Dio e Ruggi d’Aragona', Salerno, Italy
  15. 15 Radiology-Neuroradiology, Osp. SS. Annunziata ASL Taranto, Taranto, Italy
  16. 16 Neuroradiology, Ospedale di Varese, Varese, Italy
  17. 17 Interventional Neurovascular Unit, University Hospital Careggi, Firenze, Italy
  18. 18 Neurology and Psychiatry, Universita degli Studi di Roma La Sapienza Facolta di Scienze Matematiche Fisiche e Naturali, Roma, Italy
  1. Correspondence to Professor Ilaria Casetta, Neurology, Università degli Studi di Ferrara, Ferrara, Emilia-Romagna, Italy; cti{at}


Background Clinical trials and observational studies have demonstrated the benefit of thrombectomy up to 16 or 24 hours after the patient was last known to be well. This study aimed to evaluate the outcome of stroke patients treated beyond 24 hours from onset.

Methods We analyzed the outcome of 34 stroke patients (mean age 70.7±12.3 years; median National Institutes of Health Stroke Scale (NIHSS) score 13) treated with endovascular thrombectomy beyond 24 hours from onset who were recruited in the Italian Registry of Endovascular Thrombectomy in Acute Stroke. Selection criteria for patients were: pre-stroke modified Rankin scale (mRS) score of ≤2, non-contrast CT Alberta Stroke Program Early CT score of ≥6, good collaterals on single phase CT angiography (CTA) or multiphase CTA, and CT perfusion mismatch with an infarct core size ≤50% of the total hypoperfusion extent or involving less than one-third of the extent of the middle cerebral artery territory evaluated by visual inspection. The primary outcome measure was functional independence assessed by the mRS at 90 days after onset. Safety outcomes were 90 day mortality and the occurrence of symptomatic intracranial hemorrhage (sICH).

Results Successful recanalization (Thrombolysis in Cerebral Infarction score of 2b or 3) was present in 76.5% of patients. Three month functional independence (mRS score 0–2) was observed in 41.1% of patients. The case fatality rate was 26.5%. and the incidence of sICH was 8.8%.

Conclusions These findings suggest that, in a real world setting, very late endovascular therapy is feasible in appropriately selected patients.

  • stroke
  • thrombectomy
  • CT perfusion

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  • Collaborators The Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS).

  • Contributors IC, EF, and DT: conceptualized and designed the study, collected and analyzed the data, and drafted the manuscript. VS, SM, AZ, and AS: conceptualized and designed the study, collected the data, revised the manuscript, and supervised the project. Other authors: collected the data and reviewed the manuscript for intellectual content.

  • Funding The project ‘‘Registro Nazionale Trattamento Ictus Acuto’’ (RFPS-2006-1-336562) was funded by grants from the Italian Ministry of Health within the framework of the 2006 Finalized Research Programmes (D.Lgs.n.502/1992).

  • Competing interests MB: Penumbra Europe proctorship. DR: consultant for Penumbra Inc. AS: consultant for Stryker. AZ: received speaker fees from Ceronovus and is on the advisory board for Stryker.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.