TY - JOUR T1 - Association between time to treatment and clinical outcomes in endovascular thrombectomy beyond 6 hours without advanced imaging selection JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 336 LP - 342 DO - 10.1136/neurintsurg-2021-018564 VL - 15 IS - 4 AU - Permesh Singh Dhillon AU - Waleed Butt AU - Anna Podlasek AU - Norman McConachie AU - Robert Lenthall AU - Sujit Nair AU - Luqman Malik AU - Pervinder Bhogal AU - Hegoda Levansri Dilrukshan Makalanda AU - Oliver Spooner AU - Kailash Krishnan AU - Nikola Sprigg AU - Alex Mortimer AU - Thomas Calvert Booth AU - Kyriakos Lobotesis AU - Philip White AU - Martin A James AU - Philip Bath AU - Robert A Dineen AU - Timothy J England Y1 - 2023/04/01 UR - http://jnis.bmj.com/content/15/4/336.abstract N2 - Background The effectiveness and safety of endovascular thrombectomy (EVT) in the late window (6–24 hours) for acute ischemic stroke (AIS) patients selected without advanced imaging is undetermined. We aimed to assess clinical outcomes and the relationship with time-to-EVT treatment beyond 6 hours of stroke onset without advanced neuroimaging.Methods Patients who underwent EVT selected with non-contrast CT/CT angiography (without CT perfusion or MR imaging), between October 2015 and March 2020, were included from a national stroke registry. Functional and safety outcomes were assessed in both early (<6 hours) and late windows with time analyzed as a continuous variable.Results Among 3278 patients, 2610 (79.6%) and 668 (20.4%) patients were included in the early and late windows, respectively. In the late window, for every hour delay, there was no significant association with shift towards poorer functional outcome (modified Rankin Scale (mRS)) at discharge (adjusted common OR 0.98, 95% CI 0.94 to 1.01, p=0.27) or change in predicted functional independence (mRS ≤2) (24.5% to 23.3% from 6 to 24 hours; aOR 0.99, 95% CI0.94 to 1.04, p=0.85). In contrast, predicted functional independence was time sensitive in the early window: 5.2% reduction per-hour delay (49.4% to 23.5% from 1 to 6 hours, p=0.0001). There were similar rates of symptomatic intracranial hemorrhage (sICH) (3.4% vs 4.6%, p=0.54) and in-hospital mortality (12.9% vs 14.6%, p=0.33) in the early and late windows, respectively, without a significant association with time.Conclusion In this real-world study, there was minimal change in functional disability, sICH and in-hospital mortality within and across the late window. While confirmatory randomized trials are needed, these findings suggest that EVT remains feasible and safe when performed in AIS patients selected without advanced neuroimaging between 6–24 hours from stroke onset.Data may be obtained from a third party and are not publicly available. Data access requests should be directed to SSNAP as the data provider and HQIP as the data controller. ER -