{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T06:15:27Z","timestamp":1793168127740,"version":"4.5.0"},"reference-count":22,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:sec id=\"ab-noi220084-4\"><jats:title>Importance<\/jats:title><jats:p>The role of endovascular thrombectomy is uncertain for patients presenting beyond 24 hours of the time they were last known well.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi220084-5\"><jats:title>Objective<\/jats:title><jats:p>To evaluate functional and safety outcomes for endovascular thrombectomy (EVT) vs medical management in patients with large-vessel occlusion beyond 24 hours of last known well.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi220084-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective observational cohort study enrolled patients between July 2012 and December 2021 at 17 centers across the United States, Spain, Australia, and New Zealand. Eligible patients had occlusions in the internal carotid artery or middle cerebral artery (M1 or M2 segment) and were treated with EVT or medical management beyond 24 hours of last known well.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi220084-7\"><jats:title>Interventions<\/jats:title><jats:p>Endovascular thrombectomy or medical management (control).<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi220084-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Primary outcome was functional independence (modified Rankin Scale score 0-2). Mortality and symptomatic intracranial hemorrhage (sICH) were safety outcomes. Propensity score (PS)\u2013weighted multivariable logistic regression analyses were adjusted for prespecified clinical characteristics, perfusion parameters, and\/or Alberta Stroke Program Early CT Score (ASPECTS) and were repeated in subsequent 1:1 PS-matched cohorts.<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi220084-9\"><jats:title>Results<\/jats:title><jats:p>Of 301 patients (median [IQR] age, 69 years [59-81]; 149 female), 185 patients (61%) received EVT and 116 (39%) received medical management. In adjusted analyses, EVT was associated with better functional independence (38% vs control, 10%; inverse probability treatment weighting adjusted odds ratio [IPTW aOR], 4.56; 95% CI, 2.28-9.09; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001) despite increased odds of sICH (10.1% for EVT vs 1.7% for control; IPTW aOR, 10.65; 95% CI, 2.19-51.69; <jats:italic>P<\/jats:italic>\u2009=\u2009.003). This association persisted after PS-based matching on (1) clinical characteristics and ASPECTS (EVT, 35%, vs control, 19%; aOR, 3.14; 95% CI, 1.02-9.72; <jats:italic>P<\/jats:italic>\u2009=\u2009.047); (2) clinical characteristics and perfusion parameters (EVT, 35%, vs control, 17%; aOR, 4.17; 95% CI, 1.15-15.17; <jats:italic>P<\/jats:italic>\u2009=\u2009.03); and (3) clinical characteristics, ASPECTS, and perfusion parameters (EVT, 45%, vs control, 21%; aOR, 4.39; 95% CI, 1.04-18.53; <jats:italic>P<\/jats:italic>\u2009=\u2009.04). Patients receiving EVT had lower odds of mortality (26%) compared with those in the control group (41%; IPTW aOR, 0.49; 95% CI, 0.27-0.89; <jats:italic>P<\/jats:italic>\u2009=\u2009.02).<\/jats:p><\/jats:sec><jats:sec id=\"ab-noi220084-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this study of treatment beyond 24 hours of last known well, EVT was associated with higher odds of functional independence compared with medical management, with consistent results obtained in PS-matched subpopulations and patients with presence of mismatch, despite increased odds of sICH. Our findings support EVT feasibility in selected patients beyond 24 hours. Prospective studies are warranted for confirmation.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaneurol.2022.4714","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T16:01:21Z","timestamp":1672156881000},"page":"172","source":"Crossref","is-referenced-by-count":83,"title":["Association of Endovascular Thrombectomy vs Medical Management With Functional and Safety Outcomes in Patients Treated Beyond 24 Hours of Last Known Well"],"prefix":"10.1001","volume":"80","author":[{"given":"Amrou","family":"Sarraj","sequence":"first","affiliation":[{"name":"Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio"},{"name":"Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Kleinig","sequence":"additional","affiliation":[{"name":"Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, 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