RT Journal Article SR Electronic T1 Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP jnis-2022-019372 DO 10.1136/jnis-2022-019372 A1 Amir Shaban A1 Sami Al Kasab A1 Reda M Chalhoub A1 Eric Bass A1 Ilko Maier A1 Marios-Nikos Psychogios A1 Ali Alawieh A1 Stacey Q Wolfe A1 Adam S Arthur A1 Travis M Dumont A1 Peter Kan A1 Joon-tae Kim A1 Reade De Leacy A1 Joshua W Osbun A1 Ansaar T. Rai A1 Pascal Jabbour A1 Min S Park A1 Roberto Javier Crosa A1 Justin R Mascitelli A1 Michael R Levitt A1 Adam J Polifka A1 Walter Casagrande A1 Shinichi Yoshimura A1 Charles Matouk A1 Richard Williamson A1 Benjamin Gory A1 Maxim Mokin A1 Isabel Fragata A1 Daniele G Romano A1 Shakeel Chowdry A1 Mark Moss A1 Daniel Behme A1 Kaustubh Limaye A1 Alejandro M Spiotta A1 Edgar A Samaniego YR 2023 UL http://jnis.bmj.com/content/early/2023/01/02/jnis-2022-019372.abstract AB 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.