{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T13:58:49Z","timestamp":1772891929636,"version":"3.50.1"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>It remains unclear whether outcomes of patients treated with endovascular thrombectomy with large-vessel occlusion and unwitnessed onset of stroke differ from those with witnessed onset in the extended time window.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We enrolled patients with anterior circulation large-vessel occlusion (internal carotid artery, M1, or M2 segment of the middle cerebral artery) undergoing endovascular thrombectomy within 6 to 24 hours from the time last seen well, from 2014 to 2022, at 66 sites in Europe, North America, and Asia. Patients with a prestroke modified Rankin Scale score of &gt;3 or age &lt;18 were excluded. We categorized patients by onset mode as witnessed or unwitnessed. The primary outcome was the modified Rankin Scale shift at 90 days. Secondary outcomes were functional independence, a composite of functional independence or return of Rankin to prestroke level, symptomatic intracranial hemorrhage, mortality, and a composite of severe disability or mortality at 90 days. We applied inverse probability of treatment weighting to compare outcomes between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 5098 patients assessed for eligibility, we included 2073, of whom 1760 (84.9%) had unwitnessed onset, and 313 (15.1%) were witnessed. In the univariate comparison (before inverse probability of treatment weighting), 38.8% of the unwitnessed and 45.7% of the witnessed patients achieved functional independence (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.022). Mortality was 21.6% among unwitnessed and 22.0% among witnessed (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.847), and symptomatic intracranial hemorrhage rates were 6.6% and 5.8%, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.623). The primary outcome (modified Rankin Scale shift) showed no difference comparing unwitnessed to witnessed patients (odds ratio, 1.35 [95% CI, 0.82\u20132.20];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.235) in the inverse probability of treatment weighting. Unwitnessed patients were more likely to achieve functional independence or return of Rankin (1.53 [1.01\u20132.33];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.045). Other secondary outcomes did not differ between the witnessed and unwitnessed patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In the extended time window, unwitnessed patients with large-vessel occlusion undergoing endovascular thrombectomy have at least the same likelihood of favorable outcomes as witnessed patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT04096248.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.052355","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T10:00:57Z","timestamp":1762941657000},"page":"362-370","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of Witnessed Versus Unwitnessed Patients With Stroke After Endovascular Therapy in the Extended Time Window"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct04096248","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9369-5846","authenticated-orcid":true,"given":"Liisa","family":"Tomppo","sequence":"first","affiliation":[{"name":"Department of Neurology (L.T., N.M.-M., D.S.), Helsinki University Hospital, University of Helsinki, Finland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8489-7051","authenticated-orcid":true,"given":"Nicolas","family":"Martinez-Majander","sequence":"additional","affiliation":[{"name":"Department of Neurology (L.T., N.M.-M., D.S.), Helsinki University Hospital, University of Helsinki, Finland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2056-3308","authenticated-orcid":true,"given":"Muhammad M.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Radiation Oncology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (M.M.Q.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2810-1685","authenticated-orcid":true,"given":"Thanh N.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N., P.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4532-153X","authenticated-orcid":true,"given":"Raul G.","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (R.G.N.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2471-6647","authenticated-orcid":true,"given":"Simon","family":"Nagel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Klinikum Ludwigshafen, Germany (S.N.)."},{"name":"Department of Neurology (S.N., P.A.R.), Heidelberg University Hospital, Germany."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8186-0237","authenticated-orcid":true,"given":"Jelle","family":"Demeestere","sequence":"additional","affiliation":[{"name":"Department of Neurology, UZ Leuven, Belgium (J.D., A.W., R.L.)."},{"name":"Laboratory for Neurobiology, KU Leuven, Belgium (J.D., A.W., R.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1415-3027","authenticated-orcid":true,"given":"Volker","family":"Puetz","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany (V.P., S.W.)."},{"name":"Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany (V.P., D.P.O.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6274-7562","authenticated-orcid":true,"given":"Hilde","family":"Henon","sequence":"additional","affiliation":[{"name":"Department of Neurology, Centre Hospitalier Universitaire de Lille, France (H.H., F.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4637-1598","authenticated-orcid":true,"given":"Marta","family":"Olive-Gadea","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Vall d\u2019Hebron, Barcelona, Spain (M.O.-G., M.R., J.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2277-5950","authenticated-orcid":true,"given":"Jo\u00e3o Pedro","family":"Marto","sequence":"additional","affiliation":[{"name":"Department of Neurology (J.P.M., R.V.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9988-2783","authenticated-orcid":true,"given":"Anne","family":"Dusart","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4pital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5473-8671","authenticated-orcid":true,"given":"Peter A.","family":"Ringleb","sequence":"additional","affiliation":[{"name":"Department of Neurology (S.N., P.A.R.), Heidelberg University Hospital, Germany."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4881-4698","authenticated-orcid":true,"given":"Osama O.","family":"Zaidat","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH (O.O.Z., E.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1884-2196","authenticated-orcid":true,"given":"Diogo C.","family":"Haussen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Grady Memorial Hospital, Atlanta, GA (D.C.H., M.H.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7393-9989","authenticated-orcid":true,"given":"Mahmoud H.","family":"Mohammaden","sequence":"additional","affiliation":[{"name":"Department of Neurology, Grady Memorial Hospital, Atlanta, GA (D.C.H., M.H.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9528-301X","authenticated-orcid":true,"given":"Mohamad","family":"Abdalkader","sequence":"additional","affiliation":[{"name":"Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (M.A., M.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1978-4274","authenticated-orcid":true,"given":"Jean","family":"Raymond","sequence":"additional","affiliation":[{"name":"Department of Interventional Neuroradiology, Centre Hospitalier de l\u2019Universite de Montreal, Canada (J.R., D.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3408-1297","authenticated-orcid":true,"given":"Santiago","family":"Ortega-Gutierrez","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa, Iowa City (S.O.-G., J.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0602-8509","authenticated-orcid":true,"given":"Sunil A.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Department of Neurology, UTHealth McGovern Medical School, Neurology, Houston, TX (S.A.S., S.S.-M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8133-3314","authenticated-orcid":true,"given":"Hiroshi","family":"Yamagami","sequence":"additional","affiliation":[{"name":"Division of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Japan (H.Y.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9678-3422","authenticated-orcid":true,"given":"Jo\u00e3o Nuno","family":"Ramos","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6627-0893","authenticated-orcid":true,"given":"Francois","family":"Caparros","sequence":"additional","affiliation":[{"name":"Department of Neurology, Centre Hospitalier Universitaire de Lille, France (H.H., F.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5258-0025","authenticated-orcid":true,"given":"Daniel P.O.","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany (V.P., D.P.O.K.)."},{"name":"Institute of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany (D.P.O.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-043X","authenticated-orcid":true,"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Vall d\u2019Hebron, Barcelona, Spain (M.O.-G., M.R., J.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2722-7542","authenticated-orcid":true,"given":"Sergio","family":"Salazar-Marioni","sequence":"additional","affiliation":[{"name":"Department of Neurology, UTHealth McGovern Medical School, Neurology, Houston, TX (S.A.S., 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(A.S.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0287-3967","authenticated-orcid":true,"given":"James E.","family":"Siegler","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Chicago, IL (J.E.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4967-1801","authenticated-orcid":true,"given":"Syed F.","family":"Zaidi","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Toledo, OH (S.F.Z., M.J., A.C.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7165-797X","authenticated-orcid":true,"given":"Mouhammad","family":"Jumaa","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Toledo, OH (S.F.Z., M.J., A.C.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-1602","authenticated-orcid":true,"given":"Eugene","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH (O.O.Z., E.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9289-4658","authenticated-orcid":true,"given":"Jordi","family":"Mayol","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Vall d\u2019Hebron, Barcelona, Spain (M.O.-G., M.R., J.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0952-3353","authenticated-orcid":true,"given":"Rita","family":"Ventura","sequence":"additional","affiliation":[{"name":"Department of Neurology (J.P.M., R.V.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Portugal."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1757-753X","authenticated-orcid":true,"given":"Simon","family":"Winzer","sequence":"additional","affiliation":[{"name":"Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universit\u00e4t Dresden, Germany (V.P., S.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7468-137X","authenticated-orcid":true,"given":"Piers","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (T.N.N., P.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavio","family":"Bellante","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4pital Civil Marie Curie, Charleroi, Belgium (A.D., 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