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Updated: Jan 15, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Endovascular treatment beyond 24 hours for large vessel occlusion strokes selected by CT perfusion
Changzhu Wu1, Xianwei Wang1, Lingling Zhang1
1Department of Neurology, Taizhou Hospital of Zhejiang Province, Taizhou City, Zhejiang Province, People's Republic of China.
Background:
The role that endovascular treatment (EVT) may play in stroke patients with large vessel occlusion (LVO) who are treated beyond 24 h after onset is unclear. In this study, we aimed to examine the efficacy and safety of EVT beyond 24 h based on uniform CT perfusion criteria in appropriately selected patients.
Methods:
A retrospective review was performed at a single stroke center between January 2021 and August 2024. We chose patients who received EVT beyond 24 h while a matched group who received EVT within the 6-24 h time window was chosen as a control. Functional independence (modified Rankin scale score ≤2) at 90 days was used as the primary outcome, and symptomatic intracranial hemorrhage (sICH) and mortality were considered safety outcomes.
Results:
We selected 400 patients treated with EVT within the 6-24 h time window (late window group) and 82 patients treated beyond 24 h (very late window group). A 2:1 matched group was used for comparison. No significant differences in functional independence (very late, 58.5% vs late, 61.6%, OR, 1.14, 95% CI, 0.66-1.95, p = 0.645) at 90 days, safety outcomes of mortality (very late, 7.3% vs late, 9.8%, OR, 0.73, 95% CI, 0.28-1.94, p = 0.786), or sICH (very late, 2 (2.4%) vs late, 5 (3.0%), OR, 0.80, 95% CI, 0.15-4.19, p = 0.527). Patients with a course of neurological deterioration before EVT tend to have a good prognosis (OR = 27.129, 95% CI, 2.559-288.906, p=0.006).
Conclusions:
Compared with EVT performed within the 6-24 h, EVT beyond 24 h appears to be feasible and safe for acute LVO stroke patients selected by CT perfusion.
