TY - JOUR T1 - Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/jnis-2022-019372 SP - jnis-2022-019372 AU - Amir Shaban AU - Sami Al Kasab AU - Reda M Chalhoub AU - Eric Bass AU - Ilko Maier AU - Marios-Nikos Psychogios AU - Ali Alawieh AU - Stacey Q Wolfe AU - Adam S Arthur AU - Travis M Dumont AU - Peter Kan AU - Joon-tae Kim AU - Reade De Leacy AU - Joshua W Osbun AU - Ansaar T. Rai AU - Pascal Jabbour AU - Min S Park AU - Roberto Javier Crosa AU - Justin R Mascitelli AU - Michael R Levitt AU - Adam J Polifka AU - Walter Casagrande AU - Shinichi Yoshimura AU - Charles Matouk AU - Richard Williamson AU - Benjamin Gory AU - Maxim Mokin AU - Isabel Fragata AU - Daniele G Romano AU - Shakeel Chowdry AU - Mark Moss AU - Daniel Behme AU - Kaustubh Limaye AU - Alejandro M Spiotta AU - Edgar A Samaniego Y1 - 2023/01/02 UR - http://jnis.bmj.com/content/early/2023/01/02/jnis-2022-019372.abstract N2 - Background Recent clinical trials have shown that mechanical thrombectomy is superior to medical management for large vessel occlusion for up to 24 hours from onset. Our objective is to examine the safety and efficacy of thrombectomy beyond the standard of care window.Methods A retrospective review was undertaken of the multicenter Stroke Thrombectomy and Aneurysm Registry (STAR). We identified patients who underwent mechanical thrombectomy for large vessel occlusion beyond 24 hours. We selected a matched control group from patients who underwent thrombectomy in the 6–24-hour window. We used functional independence at 3 months as our primary outcome measure.Results We identified 121 patients who underwent thrombectomy beyond 24 hours and 1824 in the 6–24-hour window. We selected a 2:1 matched group of patients with thrombectomy 6–24 hours as a comparison group. Patients undergoing thrombectomy beyond 24 hours were less likely to be independent at 90 days (18 (18.8%) vs 73 (34.9%), P=0.005). They had higher odds of mortality at 90 days in the adjusted analysis (OR 2.34, P=0.023). Symptomatic intracerebral hemorrhage and other complications were similar in the two groups. In a multivariate analysis only lower number of attempts was associated with good outcomes (OR 0.27, P=0.022).Conclusions Mechanical thrombectomy beyond 24 hours appears to be safe and tolerable with no more hemorrhages or complications compared with standard of care thrombectomy. Outcomes and mortality in this time window are worse compared with an earlier time window, but the rates of good outcomes may justify this therapy in selected patients.Data are available upon reasonable request. ER -