- Question
- Does endovascular thrombectomy performed 6 to 24 hours after a patient was last known to be well improve functional outcomes in ischemic stroke patients with a mismatch between clinical deficit and infarct volume?
- Design
- Randomized, single-blind (blinded outcome assessment) trial of thrombectomy plus standard care versus standard care alone, with 206 patients. Enrollment was stopped at 31 months because of a prespecified interim analysis.
- Population
- Patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who were last known to be well 6 to 24 hours earlier, with a mismatch between clinical deficit severity and infarct volume, using criteria defined by age (<80 years or ≥80 years).
- Intervention
- Endovascular thrombectomy (Trevo device) plus standard medical management; 107 patients.
- Control
- Standard medical management alone; 99 patients.
- Primary outcome
- Coprimary endpoints at 90 days: mean utility-weighted modified Rankin scale score (0 = death, 10 = no symptoms or disability) and rate of functional independence (modified Rankin scale 0–2).
- Results
- The mean utility-weighted modified Rankin scale score was 5.5 with thrombectomy vs 3.4 in the control group (adjusted difference 2.0 points; 95% credible interval, 1.1 to 3.0; posterior probability of superiority >0.999). Functional independence at 90 days was 49% vs 13% (adjusted difference 33 percentage points; 95% credible interval, 24 to 44).
- Safety
- Symptomatic intracranial hemorrhage did not differ significantly (6% vs 3%; P=0.50), nor did 90-day mortality (19% vs 18%; P=1.00).
- Conclusion
- Among patients with acute stroke last known to be well 6 to 24 hours earlier and with a clinical-infarct mismatch, thrombectomy plus standard care yielded better 90-day disability outcomes than standard care alone.
- Why it matters
- It extended the therapeutic window for thrombectomy beyond 6 hours, showing that selecting patients by clinical and imaging criteria, rather than by elapsed time alone, can identify those who benefit from late treatment.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026