Endovascular treatment beyond 24 hours for large vessel occlusion strokes selected by CT perfusion

Endovascular treatment beyond 24 hours for large vessel occlusion strokes selected by CT perfusion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endovascular treatment beyond 24 hours for large vessel occlusion strokes selected by CT perfusion Changzhu Wu, Xianwei Wang, Hong Ni, Feng Wang, Weijun Hong, Yiqing Jiang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5424043/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The role that endovascular treatment (EVT) may play in stroke patients with large vessel occlusion (LVO) who are treated beyond 24 hours after onset is unclear. In this study, we aimed to examine the efficacy and safety of EVT beyond 24 hours based on uniform CT perfusion criteria in appropriately selected patients. Methods A retrospective review was performed at a single stroke center between January 2020 and August 2023. We chose patients who received EVT beyond 24 hours via CT perfusion. A matched group of patients who received EVT within the 6–24 hour 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 hour time window and 82 patients treated beyond 24 hours. A 2:1 matched group was used for comparison. No significant differences in functional independence (58.5% vs. 61.6%, P = 0.645), safety outcomes of sICH (7.3% vs. 9.8%, P = 0.527), or mortality (2.4% vs. 3.0%, P = 0.786) at 90 days were demonstrated. Patients who underwent EVT beyond 24 hours had a greater incidence of large-artery atherosclerosis (LAA) (89.0% vs. 75.6%; P = 0.044) and a course of neurological deterioration before EVT (78.0% vs. 43.7%; P < 0.001). According to multivariate analysis, the preoperative NIHSS score (OR = 0.770, P = 0.001), sex (OR = 4.569, P = 0.007), and pro-operative ND (OR = 27.192, P = 0.006) were associated with good outcomes. Conclusions Compared with endovascular treatment performed within the 6–24 hours, EVT beyond 24 hours appears to be feasible and safe for acute LVO stroke patients who meet the DEFUSE-3 imaging criteria based on CT perfusion. Patients with neurological deterioration during the course of the disease may be a suitable screening population for super late window EVT. Figures Figure 1 INTRODUCTION Endovascular treatment (EVT) has revolutionized the management of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). Multiple high-quality randomized controlled trials have demonstrated the efficacy and safety of EVT in patients who present within 6 hours of their last known well [ 1 – 5 ] . More recently, the DEFUSE 3 and DAWN trials, which utilized strict inclusion criteria and advanced neuroimaging, demonstrated the superiority of performing EVT for patients who presented within a 6–24 hour window [ 6 – 7 ] . These findings have shifted the patient selection criteria for EVT from the traditional “time window” to the “tissue window”. Cerebral infarction volume expansion occurs at a different pace in different patients [ 24 ] . In a subset of DEFUSE 3 patients, persistent penumbral tissue was present after 24 hours and was associated with a subsequent increase in infarct volume and worsening of neurological function [ 8 – 9 ] . However, imaging findings of salvageable tissue do not ensure clinical improvement, and potential reperfusion injury and operation-related complications remain a concern. Several studies focusing on the safety and effectiveness of EVT beyond 24 hours from the last known well have demonstrated potentially promising results [ 8 , 13 , 14 ] . However, the evidence is limited, especially concerning the use of imaging screening criteria for patients presenting beyond 24 hours after undergoing EVT because of the paucity of high-level studies. Using computed tomography (CT) perfusion imaging, we sought to assess the functional and safety outcomes of EVT in patients who presented beyond 24 hours of last known well after strict clinical and imaging screening. We evaluated this possibility by comparing patients who received EVT for more than 24 hours to a matched control group of patients who received EVT in the 6–24 hour time window. We also aimed to identify the factors associated with good outcomes in patients who underwent EVT for more than 24 hours of last known well. Methods Study population A retrospective study of patients with AIS who underwent EVT at a single high-volume stroke center between January 2020 and August 2023 was performed. We analysed all patients who underwent EVT beyond 24 hours (very late window) after their last known well time and chose patients who received EVT within the 6–24 hour (late window) time window as a comparison group. Rescue EVT was performed considering the risk and benefit for patients who presented with mild stroke but experienced neurological deterioration (increased NIHSS score ≥ 2) at any time during hospitalization due to LVO [ 10 ] . The 6–24 hour group was chosen for comparison because it closely resembled the very late group in that there was a greater likelihood of receiving advanced imaging evaluation and a lower likelihood of receiving intravenous thrombolysis before EVT. Patient baseline characteristics, including sex, age, National Institutes of Health Stroke Scale (NIHSS) score before EVT, mismacth volume and artery occlusion site (anterior vs. posterior) were used for propensity score matching. Patients in the very late window group (> 24 hours) were matched 1:2 with patients in the 6–24 hour time window group (nearest neighbour algorithm, with a tolerance of 0.2). Matching was performed without replacement, and unpaired patients who did not meet the matching criteria were excluded. Each PSM-derived pair was created using a full matching algorithms with R package MatchIt. The study was approved by the Institutional Review Board of Taizhou Hospital of Zhejiang Province, Taizhou, China. Inclusion and exclusion criteria The inclusion criteria were as follows: (1) had a stroke onset time or a duration from the last known well to arterial puncture exceeding 6 hours; (2) ≥ 18 years of age; (3) had a brain CTP in all patients. For patients with clinical neurological deterioration (ND), CTP was reevaluated after ND. Automatic analysis was performed by RAPID software (iSchema View); for a time window of more than 24 hours: met the following imaging criteria of DEFUSE 3, an ischemic core volume 6) to an infarct volume ≥ 1.8; for a time window of 6–24 hours: met the imaging criteria of DEFUSE 3; (4) large vessel occlusion confirmed by CT angiography and clinically confirmed as the responsible lesion of the current stroke; (5) all patients were examined by CT immediately before the intervention, an Alberta Stroke Program Early CT Score (ASPECTS) ≥ 6; (6) successful reperfusion at the end of the procedure (modified thrombolysis in cerebral infarction [mTICI] score of 2b to 3). The reasons for unsuccessful reperfusion were complex, including catheter failure to access the lesion due to vascular tortuosity, which was not caused by the stroke itself, and the prognosis of these patients does not reflect the effect of the intervention, so we included only successfully reperfused patients. The exclusion criteria were as follows: (1) had a modified Ranking Scale (mRS) score ≥ 3 before the onset of this stroke; (2) had active bleeding or known signs of obvious bleeding or a history of advanced malignant tumor; (3) were allergic to contrast media or narcotic drugs; (4) had severe damage to liver and kidney function; and (5) had unknown time parameters or missing mRS data at the 90-day follow-up. Treatment Patients in both groups underwent EVT, which included mechanical thrombectomy and endovascular angioplasty. Femoral artery puncture was performed after general or local anaesthesia. The microguide wire was used with a microcatheter to pass through the occlusion. Mechanical thrombectomy was administered by the means of direct aspiration via an intermedian catheter, a stent retriever, or a combination. A stent retriever was placed and released in the occlusion section through the microcatheter for 5 minutes and then pulled out of the body, during which the 5F or 6F intermediate catheter continued negative pressure suction. After successful thrombectomy, if the residual stenosis is more than 70% and the distal blood reperfusion is insufficient, or if the residual stenosis segment is reblocked after 10 min of observation, endovascular angioplasty, including balloon dilatation only or with a stent, can be performed in the stenotic segment. Angioplasty was directly utilized for subtotal occlusion. Ten minutes before angioplasty, a loading dose (10 mg/kg) of the glycoprotein IIb/IIIa inhibitor tirofiban was administered through an arterial catheter for 10 minutes. This was followed by intravenous infusion at 0.1 mg/kg/min. This infusion was continued for 24 hours after the operation.. For tandem occlusion, the distal vessels were treated by thrombectomy while the proximal vessels were treated by angioplasty. All patients were examined by CT immediately and 24 hours after the operation. Clinical Outcomes We selected functional independence (defined as an mRS ranging from 0–2) at the 90 ± 14 day follow-up after treatment as our primary outcome. We used postprocedural symptomatic intracranial hemorrhage (defined as any intracranial bleeding associated with an increase in the NIHSS score of 4 points from the baseline according to the SITS-MOST [ 23 ] definition) and a mortality rate of 90 ± 14 days as primary safety outcomes. Additional secondary outcomes included the NIHSS score at discharge, good functional outcome (mRS 0–1) at 90 days, and other complications (pneumonia, venous thrombus embolism, and gastrointestinal bleeding) at discharge. We also investigated the factors associated with functional independence in patients who underwent EVT more than 24 hours prior. Statistical analyses Statistical Package for the Social Sciences (SPSS, version 23.0) software was used for analysis, and all the statistical analyses were carried out at a significance level of 5%. The baseline characteristics of the two groups are presented as the means ± standard deviations or medians (interquartile distances) for quantitative data and as the rates or composition ratios for qualitative data. The chi-square test or Fisher exact probability method was used to compare the binary count data, and the group t test or Wilcoxon rank sum test was used to compare the measurement data; Two-way repeated measures ANOVA was used to compare the interaction between the occlusion vessel and time window in subgroup analyses. A two-tailed alpha was used for all analyses. Forward stepwise binary logistic regression ( P < 0.1) analysis was used to assess which variables predicted good outcome. Results Study population and baseline characteristics A total of 1116 patients were initially admitted to our stroke center for EVT between January 2020 and August 2023. Of these, 29 patients with missing mRS and CTP data, 5 patients with advanced malignant tumors, 8 patients with unsuccessful reperfusion (mTICI 0-2a) (2 patients presented > 24 hours, 6 patients presented 6–24 hours), and 592 patients treated within 6 hours were excluded (Fig. 1 ). Eighty-two patients were treated beyond 24 hours, and 400 patients treated at 6–24 hours after the last known well time were included. The median duration from the last known well-to-puncture for patients receiving EVT beyond 24 hours was 48 hours and ranged from 27–145 hours. Among them, 34 patients arrived at the hospital within 24 hours of last know well with mild symptoms (the NIHSS score ranged from 0–3), and were treated with EVT after neurological deterioration during hospitalization. All the other patients had passed the 24-hour time window when they arrived at the hospital. Table 1 shows the baseline clinical information, angiographic findings and procedural technique of the study population stratified based on the time window. After matching, 164 patients were included in the “late window” group, and 82 patients were included in the “very late window” group. Patients who were treated with EVT for more than 24 hours had a greater incidence of large-artery atherosclerosis (LAA) (89.0% vs. 75.6%; P = 0.044), a greater percentage of patients requiring endovascular angioplasty (78.0% vs. 43.7%; P < 0.001), and a greater percentage of rescue EVT for neurological deterioration patients (85.4% vs. 45.7%; P < 0.001). Twelve patients experienced a gradual deterioration and 58 patients experienced a sudden and significant deterioration. All patients underwent rescue EVT within 24 hours of the last deterioration. No significant differences were observed in the remaining baseline clinical or imaging characteristics. The distribution of propensity scores and standardized mean differences before and after matching are presented in Supplemental Figs. 1 and table 1 respectively. Table 1. Baseline characteristics of the study population Before PSM P After PSM P ＞24 hours 6-24 hours ＞24 hours 6-24 hours Sample size 82 400 82 164 Age, median (IQR), y 67（60-74） 71（59-78） 0.459 67（60-74） 68（60-74） 0.853 Sex(male,n[%]) 49（59.7） 227（56.7） 0.616 49（59.7） 98（59.7） Hypertension (n[%]) 57（69.5） 249（62.3） 0.213 57（69.5） 97（59.1） 0.113 Diabetes (n [%]) 28（34.1） 97（24.3） 0.063 28（34.1） 44（25.4） 0.149 Atrial fibrillation (n [%]) 6（7.3） 113（28.3） ＜0.001* 6（7.3） 26（15.9） 0.061 Prior stroke(n[%]) 14（17.1） 81（20.3） 0.510 14（17.1） 34（20.7） 0.495 Prior use of Antiplatelet 18（2.0） 95（23.75） 0.726 18（22.0） 34（20.7） 0.825 pre-stroke mRS(IQR) 0（0-0） 0（0-0） 0.182 0（0-0） 0（0-0） 0.449 Stroke with exact onset time 53（64.6） 223（55.8） 0.108 53（64.6） 103（62.8） 0.688 LKW-Puncture time（hour） 48.63（35.23-70.0） 7.79（4.17-12.07） 0.000* 48.63（35.23-70.0） 11.26（7.87-14.79） 0.000* TOAST classification LAA 73（89.0） 265（66.3） ＜0.001* 73（89.0） 124（75.6） 0.044* Cardioembolism 5（6.1） 111（27.8） 5（6.1） 25（15.2） Other determined 3（3.7） 16（4.0） 3（3.7） 7（4.3） Undetermined 1（1.2） 8（2.0） 1（1.2） 8（4.9） Pro-operative NIHSS (IQR) 8（7-12） 13（8-17） ＜0.001* 8（7-12） 11（8-13） 0.069 Pro-operative mRS (IQR) 4 (4-5) 4 (4-5) 0.491 4 (4-5) 4 (4-5) 0.378 IV Thrombolysis 6（7.3） 66（16.5） 0.034* 6（7.3） 24（14.6） 0.098 Pro-operative ND 70（85.4） 125（31.3） 0.000* 70（85.4） 75（45.7） ＜0.001* Pro-operative ASPECTS (IQR) 8（7-9） 9（7-10） 0.325 8（7-9） 8（7-9） 0.446 CTP (IQR, ml) Ischemic core volume 1.6（0-7.5） 5.3（0-17.6） 0.151 1.6（0-7.5） 4.8（0-15.9） 0.464 Mismacth volume 94（47-125） 40.8（83.3-119.1） 0.760 94（47-125） 90（46-131） 0.617 Occlusion site (n [%]) 0.699 0.817 ICA 15（18.3） 73（18.3） 15（18.3） 25（15.2） M1 35（42.7） 167（41.8） 35（42.7） 75（45.7） M2 8（9.8） 63（15.8） 8（9.8） 13（7.9） Tandem occlusion of anterior circulation 3（3.7） 19（4.8） 3（3.7） 11（6.7） A1 3（3.7） 8（2.0） 3（3.7） 4（2.4） BA 9（11.0） 45（11.3） 9（11.0） 22（13.4） V4 6（7.3） 17（4.3） 6（7.3） 9（5.5） Tandem occlusion of posterior circulation 3（3.7） 8（2.0） 3（3.7） 5（3.0） Technique(n[%]) Clot retrieval 18（22.0） 278（69.5） ＜0.001* 18（22.0） 76（46.3） ＜0.001* Clot retrieval plus angioplasty 47（57.3） 100（25.0） 47（57.3） 72（43.9） Angioplasty directly 17（20.7） 22（5.5） 17（20.7） 16（9.8） Stent implantation 17（20.7） 53（13.3） 0.08 17（20.7） 26（15.8） 0.342 Attempts 1.1±0.8 1.2±0.7 0.152 1.1±0.8 1.2±0.7 0.104 Abbreviations: PSM, propensity score matching; IQR, interquartile range; SD, standard deviation; ND, neurological deterioration; CTP, computed tomography perfusion; TOAST, trial of org 10172 in acute stroke treatment; NIHSS, National Institutes of Health Stroke Scale; ICA, intracranial internal carotid artery; M1, M2, segments of middle cerebral artery; A1, segments of anterior cerebral artery; BA, basal artery; V4, segment of vertebral artery; Tandem occlusion, proximal anterior circulation intracranial occlusion with an ipsilateral ICA high-grade stenosis or occlusion, or proximal posterior circulation intracranial occlusion with a vertebral artery high-grade stenosis or occlusion; ND, neurological deterioration; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale. LKW, last known well. Outcome measures The clinical and safety outcomes are shown in Table 2. Patients in the very late window had higher NIHSS scores at discharge (4[2-6] vs. 3[1-8]; P =0.004) but had similar chances of achieving functional independence (mRS 0-2) and good functional outcomes (mRS 0-1) at 90 days than did those in the late window before matching. The safety outcomes, including mortality, symptomatic intracerebral hemorrhage (ICH), asymptomatic ICH, and other complications, were similar between the two groups. After matching, no significant difference was observed in the odds of achieving functional or safety outcomes across the two time windows. Table 2. Clinical and Safety Outcomes in the Study Population Before PSM After PSM ＞24 hours 6-24 hours P ＞24 hours 6-24 hours P Sample size 82 400 82 164 Discharge NIHSS(IQR) 4（2-6） 5（2-11.5） 0.004* 4（2-6） 3（1-8） 0.684 mRS at 90 days mRS≤1 32（39.0） 125（31.3） 0.171 32（39.0） 73（44.5） 0.412 mRS≤2 48（58.5） 187（46.8） 0.052 48（58.5） 101（61.6） 0.645 Mortality at 90 days 6（7.3） 61（15.3） 0.059 6（7.3） 16（9.8） 0.527 Postprocedural hemorrhage Symptomatic ICH a 2（2.4） 19（4.8） 0.524 2（2.4） 5（3.0） 0.786 Asymptomatic ICH 8（9.8） 50（12.5） 0.487 8（9.8） 20（12.2） 0.570 Other complications 37(47.6) 207（51.8） 0.369 37(47.6) 94(57.3) 0.071 Abbreviations: PSM, propensity score matching; ICH, intracranial hemorrhage; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale. a , Definition of SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study).criteria. Factors predicting good outcomes after EVT for more than 24 hours Multivariate logistic regression analysis revealed that the preoperative NIHSS score (OR=0.668, P =0.002), male sex (OR=5.545, P =0.020), pro-operative ND (OR=27.192, P =0.006) were predictors of good outcomes(mRS≤2) in patients who underwent EVT longer than 24 hours (Table 3). All the other factors, including sex, age, hypertension, diabetes status, atrial fibrillation status, thrombolysis status, last know well-puncture time, pre-stroke mRS, CTP data, treatment technique and occlusion artery were not significantly associated with good prognosis. Table 3. Results of multivariate analysis of factors that are predictive of clinical good outcome in patients who underwent EVT beyond 24 hours Factor OR (95% CI) P Sex(male) 5.545(1.720-17.880) 0.004* Pro-treatment NIHSS score 0.668(0.519-0.859) 0.002* pre-stroke mRS 0.065(0.002-1.981) 0.117 Pro-operative ND 27.192(2.559-288.906) 0.006* Postprocedural hemorrhage 1.061(0.235-4.790) 0.939 Symptomatic ICH a Asymptomatic ICH Age 0.996(0.916-1.082) 0.916 Hypertension 0.181(0.024-1.333) 0.093 Diabetes 1.146(0.223-1.877) 0.870 Atrial fibrillation 3.831(0.175-83.791) 0.393 LKW-Puncture time 0.999(0.975-1.023) 0.908 occlusion artery 0.889(0.117-6.749) 0.909 anterior circulation posterior circulation Pro-operative ASPECTS 0.972(0.469-2.011) 0.938 CTP Ischemic core volume 1.022(0.950-1.100) 0.554 Mismacth volume 0.993(0.981-1.004) 0.214 Technique(n[%]) 0.081(0.004-1.852) 0.115 Clot retrieval Clot retrieval plus angioplasty Angioplasty directly Subgroup analysis Comparisons between anterior and posterior circulation occlusions are shown in Table 4. There was no interaction ( P =0.406) between the location of occlusive vessels (anterior or posterior ) and the time window (6-24 hours or ＞24 hours ) for good outcomes(mRS≤2). No statistically significant differences were detected in the functional or safety outcomes between the two time window groups for anterior or posterior circulation occlusion. When patients who received EVT beyond 24 hours were analyzed separately, a higher rate of mortality (1.6% vs 27.8%, P =0.001) was observed in patients with large vessel occlusion in the posterior circulation (Table 5). There was no significant difference in functional outcomes or other safety measures between patients with different occlusion sites. Table 4. Comparison between two time windows of anterior and posterior circulation in matched samples anterior circulation posterior circulation ＞24 hours 6-24 hours p ＞24 hours 6-24 hours p Sample size 64 128 18 36 mRS at 90 days mRS≤1 27（42.2） 61（47.7） 0.473 5（27.7） 12（33.3） 0.679 mRS≤2 40（62.5） 82（64.1） 0.832 8（44.4） 19（52.8） 0.564 Mortality at 90 days 1（1.6） 10（7.8） 0.153 5（27.7） 6（15.8） 0.292 Postprocedural hemorrhage Symptomatic ICH a 0 5（3.9） 0.262 1（5.6） 0 0.333 Asymptomatic ICH 6（9.4） 20（15.6） 0.233 2（11.1） 0 0.107 Other complications 27（42.2） 64（50.0） 0.307 12（66.7） 30（83.3） 0.165 ICH, intracranial hemorrhage; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale. a , Definition of SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study).criteria. Table 5. Comparison between the anterior and posterior circulation of patients who underwent EVT beyond 24 hours anterior circulation posterior circulation P Sample size 64 18 mRS at 90 days mRS≤1 27（42.2） 5(27.8) 0.268 mRS≤2 40（62.5） 8(44.4) 0.170 Mortality at 90 days 1（1.6） 5(27.8) 0.001* Postprocedural hemorrhage Symptomatic ICH a 0 1(5.6) 0.220 Asymptomatic ICH 6（9.4） 2(11.1) 1.000 Other complications 27（42.2） 12(66.7) 0.095 ICH, intracranial hemorrhage; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale. a , Definition of SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study).criteria. Discussion EVT has become the first choice for treating AIS with LVO in the last decade. The DEFUSE-3 and DAWN trials have expanded the time window for this revascularization to 24 hours which allows many more patients to benefit from this procedure. Physiology-based patient selection via identification of an “ischemic penumbra” via perfusion imaging represents a shift from a strictly time-based patient selection paradigm. The main finding of our study was that EVT performed beyond 24 hours based on CT perfusion evaluation achieved similar odds of functional outcome, mortality and sICH at 90 days compared to those treated between 6 and 24 hours in appropriately selected matched patients caused by large proximal artery occlusion. Previous data focused on EVT beyond 24 hours are limited. Meta-analyses of pooled rates of functional and safety outcomes showed no significant difference between the >24-hour group and the 6-24-hour group [16,17] , and other studies have shown that 90-day outcomes improve when favoring EVT in the 6-24 hour time window [14] . These conflicting results may reflect heterogeneity in the selection criteria for this population. The selection of appropriate patients for endovascular therapy through perfusion imaging assessment is the key to obtaining a good prognosis, but the optimal imaging selection criteria for patients beyond the 24-hour window remain uncertain. Only a few small sample studies have established uniform screening criteria for this group of patients. A retrospective study included 21 EVT patients who presented beyond 24 hours but met the DAWN trial imaging criteria, and found that the rates of functional outcomes and sICH were similar to those of the DAWN trial [18] . Another propensity score-matched study in Vietnam including 20 EVT patients selected based on the DAWN/DEFUSE 3 imaging criteria also demonstrated similar rates of functional and safety outcomes [19] . A single-center study from South Korea comparing outcomes in 61 patients who underwent EVT beyond 24 hours and 104 patients within 6-24 hours demonstrated similar rates of functional independence and sICH based on PWI and DWI mismatch [20] . Despite these limitations, these small sample studies demonstrated the feasibility and safety of EVT beyond 24 hours. In our study, the DEFUSE-3 CT perfusion criteria were used to screen patients, which has certain guiding significance for clinical practice. Functional independence (mRS 0–2) was achieved in 58.5% of the EVT patients who presented beyond 24 hours, which was greater than that in most studies addressing EVT beyond 24 hours [13.14,15] , but the percentage in the 6-24 hours group (61.6%) was comparable to the reported rate in randomized EVT clinical trials of AIS-LVO in 6-24 hours [6-7] . There are several potential explanations for these better results. For patients in our study, rigorous imaging criteria, including CT perfusion data and ASPECTS, were used to evaluate the ischemic penumbra, collateral circulation and infarct core to identify patients who may obtain a better prognosis through EVT. Another possible reason is that 89% of patients had large artery atherosclerotic (LAA) occlusion, which was significantly greater than that reported in other studies [13.14.15] , and ND occurred in significantly greater proportions of patients who underwent very late EVT. We also found that all patients underwent rescue EVT within 24 hours of the last deterioration, which indicates that salvageable brain tissue may still exist. Patients with LAA and a course of ND right before EVT tend to have better collateral circulation, slower symptom progression, and may achieve greater recovery of neurological function after vascular recanalization. Before matching, the preoperative NIHSS score in the >24-hour group was significantly lower than that in the 6-24-hour group. The reason may be that patients who undergo EVT beyond 24 hours often have a mild onset of disease, and most patients experience aggravated disease progression during the best drug treatment in the hospital. Doctors are advised to observe changes in the disease in a timely manner, and patients are more receptive to EVT. There was no significant difference in ischemic core volume in different time windows in this study, but we found that it appeared to be much smaller than that in a comparable study [6,7,13] . There are several reasons for this phenomenon. First, the proportion of patients with LAA involvement was greater in this study, especially in the >24-hour group, these patients tended to have better collateral circulation, and might have a smaller ischemic core volume. Second, the preoperative NIHSS score of patients with a 6-24 hour time window in this study was lower, which might also be a reason for the small ischemic core. In addition, CT perfusion data form different populations might be different. In another Chinese study, the volume of the ischemic core within 24 hours was similar to that within the 6-24 hour time window in this study [25] . In posterior circulation large vessel occlusion (P-LVO), the rate of functional outcome achievement in patients receiving EVT after 24 hours was similar to that in patients in the 6-24 time window group, but the incidence of mortality was significantly greater. At present, there are very few data on EVT beyond 24 hours with P-LVO. Only one retrospective study included 13 patients with P-LVO and found no significant differences in functional or safety outcomes between these two time windows [14] , which is different from the findings of our study. Although the sample size was small, these studies suggest that EVT may be effective for very late EVT in patients with P-LVO, but further studies are needed to evaluate its safety. This study revealed that men who underwent EVT more than 24 hours prior were more likely to have a good prognosis. Coincidentally, a Korean study of 61 patients in the very late group revealed that male sex was associated with early neurological improvement after EVT [21] , which is similar to the results of our study. Another retrospective analysis of a prospective cohort study revealed that women with acute ischemic stroke had worse outcomes, including patient-reported outcomes and functional disability [22] . Gender has been considered a confounding factor in most outcome-based studies, and identifying the factors that contribute to sex differences in stroke outcomes may help in the development of personalized stroke prevention and rehabilitation measures. However, due to the small number of patients, the confidence interval for male sex was relatively high, and we look forward to further studies with a larger sample sizes. This study suggested that the use of CT perfusion imaging to identify patients who may benefit from EVT beyond 24 hours from the last known well may be useful, especially for some large atherosclerosis patients with mild symptoms at the beginning of the disease and neurological deterioration during the course of the disease. Nonetheless, our study has several limitations. First, this was a retrospective and single-center study, and systemic bias could exist as to the selection of appropriate patients for EVT and the timing of this procedure. Second, this was not a case-control study and lacked a comparison to patients treated with best medical therapy only. Third, the small sample size limited the ability to obtain significant statistical results in our analyses of the subgroups and secondary outcomes. Conclusion In this study, EVT beyond 24 hours appeared to be functional and safe for patients with acute ischemic stroke due to LVO when it met the Deffuse3 imaging criteria. This association was consistent in propensity score-matched cohorts based on clinical characteristics. Patients with neurological deterioration during the course of the disease may be a suitable screening population for super window EVT. Randomized trials assessing the benefits and risks of EVT beyond 24 hours are warranted, and additional efforts are needed to determine the appropriate selection criteria, including clinical and imaging criteria, to identify a potential population of patients who could achieve good functional outcomes. Declarations Acknowledgements : non Author contributors: Concept and design: EW, CZW; acquisition, analysis or interpretation of data: WJC, XWW, CZW, FW, WJH, LJC; drafting of the manuscript: CZW, FW; critical revision of the manuscript for important intellectual content: EW,; statistical analysis: CZW, HN; obtained funding: EW, XWW; administrative, technical or material support: EW, FW, WJH, YQJ; supervision: EW. Data availability : The datasets analyzed in this study are available from the corresponding author upon reasonable request. Funding This study was funded by the Health Science and Technology Program of Zhejiang Provincial (number 2021KY1198 to EW) and Zhejiang Provincial Natural Science Foundation of China ( number LTGY23H090002 to XWW). Ethics approval and consent to participate: This study was approved by Medical Ethics Committee of Taizhou Hospital of Zhejiang Province. Due to the retrospective nature of the study, Ethics Committee of Taizhou Hospital of Zhejiang Province waived the need of obtaining informed consent. All methods were carried out in compliance with the Helsinki Declaration. All patients’ information was strictly anonymous and kept confidential in this manuscript. Consent for publication: The CT images and intraoperative photographs have obtained the consent of the patients or their legal representatives. The details including the patients themselves have been deleted. Competing interests: The authors declare no competing interests References Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306. doi: 10.1056/NEJMoa1503780. Epub 2015 Apr 17. PMID: 25882510. Campbell BCV, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009–18. doi: 10.1056/NEJMoa1414792. Epub 2015 Feb 11. PMID: 25671797. Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20. doi: 10.1056/NEJMoa1411587. Epub 2014 Dec 17. Erratum in: N Engl J Med. 2015 Jan 22;372(4):394. PMID: 25517348. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019–30.doi: 10.1056/NEJMoa1414905. Epub 2015 Feb 11. PMID: 25671798. Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous rt-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95. doi: 10.1056/NEJMoa1415061. Epub 2015 Apr 17. PMID: 25882376. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708–18.doi: 10.1056/NEJMoa1713973. Epub 2018 Jan 24. PMID: 29364767; PMCID: PMC6590673. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11–21. doi: 10.1056/NEJMoa1706442. Epub 2017 Nov 11. PMID: 29129157. Christensen S, Mlynash M, Kemp S, et al. Persistent target mismatch profile >24 hours after stroke onset in DEFUSE 3. Stroke. 2019;50(3):754-757. doi:10.1161/STROKEAHA.118.023392 Sarraj A, Mlynash M, Heit J, et al. Clinical outcomes and identification of patients with persistent penumbral profiles beyond 24 hours from last known well: analysis from DEFUSE 3. Stroke.2021;52(3):838-849. doi:10.1161/STROKEAHA.120.031147 .Darby DG, Barber PA, Gerraty RP, et al. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke 1999;30:2043–52. Rocha M, Jovin TG. Fast versus slow progressors of infarct growth in large vessel occlusion stroke. Stroke 2017;48:2621–7. Sarraj A, Hassan AE, Abraham M, et al. A randomized controlled trial to optimize patient’s selection for endovascular treatment in acute ischemic stroke (SELECT2): study protocol. Int J Stroke 2022;17:689-693. Sarraj A, Kleinig TJ, Hassan AE, et al. Association of endovascular thrombectomy vs medical management with functional and safety outcomes in patients treated beyond 24 hours of last known well: the SELECT Late study. JAMA Neurol. 2023;80(2):172-182. doi:10.1001/jamaneurol.2022.4714. Shaban A, Al Kasab S, Chalhoub RM, et al. Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours.J Neurointerv Surg. Published online January 2, 2023. doi:10.1136/jnis-2022-019372 Ha SH, Ryu JC, Bae JH, et al. Early Response to Endovascular Thrombectomy after Stroke: Early, Late, and Very Late Time Windows. Cerebrovasc Dis. 2023;52(1):28-35. doi: 10.1159/000525083. Epub 2022 Jun 7. PMID: 35671740. Kobeissi H, Ghozy S, Adusumilli G, et al. Endovascular Therapy for Stroke Presenting Beyond 24 Hours: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023 May 1;6(5):e2311768. doi: 10.1001/jamanetworkopen.2023.11768. PMID: 37140919; PMCID: PMC10160871. Rodriguez-Calienes A, Galecio-Castillo M, Vivanco-Suarez J, et al. Endovascular thrombectomy beyond 24 hours from last known well: a systematic review with meta-analysis. J Neurointerv Surg. 2023 Jun 24:jnis-2023-020443. doi: 10.1136/jnis-2023-020443. Epub ahead of print. PMID: 37355251. Desai SM, Haussen DC, Aghaebrahim A, et al. Thrombectomy 24 hours after stroke: beyond DAWN. J Neurointerv Surg. 2018 Nov;10(11):1039-1042. doi: 10.1136/neurintsurg-2018-013923. Epub 2018 May 28. PMID: 29807887. Casetta I, Fainardi E, Pracucci G, et al; Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS). Endovascular treatment beyond 24 hours from the onset of acute ischemic stroke: the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS). J Neurointerv Surg. 2022 Dec;14(12):1186-1188. doi: 10.1136/neurintsurg-2021-018045. Epub 2021 Nov 3. PMID: 34732532. Ha SH, Ryu JC, Bae JH, et al. Early Response to Endovascular Thrombectomy after Stroke: Early, Late, and Very Late Time Windows. Cerebrovasc Dis. 2023;52(1):28-35. doi: 10.1159/000525083. Epub 2022 Jun 7. PMID: 35671740. Ha SH, Ryu JC, Bae JH, et al. Early Response to Endovascular Thrombectomy after Stroke: Early, Late, and Very Late Time Windows. Cerebrovasc Dis. 2023;52(1):28-35. doi: 10.1159/000525083. Epub 2022 Jun 7. PMID: 35671740. Oliveira LC, Ponciano A, Tuozzo C, et al. Poststroke Disability: Association Between Sex and Patient-Reported Outcomes. Stroke. 2023 Feb;54(2):345-353. doi: 10.1161/STROKEAHA.122.041502. Epub 2023 Jan 23. PMID: 36689580. Wahlgren N, Ahmed N, Dávalos A, et al; SITS-MOST investigators. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke–Monitoring Study (SITS-MOST): an observational study. Lancet. 2007;369(9558): 275-282. doi:10.1016/S0140-6736(07)60149-4. PMID: 17258667. Rocha M, Jovin TG. Fast versus slow progressors of infarct growth in large vessel occlusion stroke: clinical and research implications. Stroke 2017;48:2621–7.doi: 10.1161/STROKEAHA.117.017673. Epub 2017 Aug 9. PMID: 28794271. Cao Z, Wang D, Feng X, et al. Assessment of Perfusion Volumes by a New Automated Software for Computed Tomography Perfusion. Stroke Vasc Neurol. 2024 Mar 28:svn-2023-002964. doi: 10.1136/svn-2023-002964. Epub ahead of print. PMID: 38548327. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5424043","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":377623871,"identity":"a9272395-93b5-4ac4-b380-b707de698de8","order_by":0,"name":"Changzhu Wu","email":"","orcid":"","institution":"Zhejiang Taizhou Hospital","correspondingAuthor":false,"prefix":"","firstName":"Changzhu","middleName":"","lastName":"Wu","suffix":""},{"id":377623872,"identity":"e12e4f70-522c-4f12-aca3-1906b93e887c","order_by":1,"name":"Xianwei Wang","email":"","orcid":"","institution":"Zhejiang Taizhou Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xianwei","middleName":"","lastName":"Wang","suffix":""},{"id":377623873,"identity":"3e7c5066-c5e9-48d2-8b5f-e77b212ff1cf","order_by":2,"name":"Hong Ni","email":"","orcid":"","institution":"Zhejiang Taizhou Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Ni","suffix":""},{"id":377623874,"identity":"5d1472b1-32ab-47e6-a0f0-aacc8f6e5535","order_by":3,"name":"Feng Wang","email":"","orcid":"","institution":"Zhejiang Taizhou Hospital","correspondingAuthor":false,"prefix":"","firstName":"Feng","middleName":"","lastName":"Wang","suffix":""},{"id":377623875,"identity":"115f4756-513c-4cd1-813b-b0e56d25181f","order_by":4,"name":"Weijun Hong","email":"","orcid":"","institution":"Enze Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weijun","middleName":"","lastName":"Hong","suffix":""},{"id":377623876,"identity":"c81a2a3f-f821-43b4-bd27-e5c4869ef513","order_by":5,"name":"Yiqing Jiang","email":"","orcid":"","institution":"Enze Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yiqing","middleName":"","lastName":"Jiang","suffix":""},{"id":377623877,"identity":"fd305e7e-60d7-4332-98b4-88fa3a84bd4a","order_by":6,"name":"Liujing Chen","email":"","orcid":"","institution":"Zhejiang Taizhou Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liujing","middleName":"","lastName":"Chen","suffix":""},{"id":377623878,"identity":"de485cc0-f503-4422-8b36-8a2046230791","order_by":7,"name":"En Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYNCCCijNQ7yWMyRrYWwjRYvB8bOHX3ycZ5Mn396d+OANg52cbgMhLWfy0ixnbksrZuw5u9lwDkOysdkBAlrMDuSYGfNuO5zYLJG7TZqH4UDiNoJazr8xM/47539im/zb7b+J03Ijx/gxY8OBxB4J3m3MRGmxv/HGjLHnWHLiDJ7czZJzDIjwi2R/jvGHHzV2ifPbz2788KbCTo6gFiBgk0CwDQgrBwHmD8SpGwWjYBSMghELAClpRJe+21wRAAAAAElFTkSuQmCC","orcid":"","institution":"Zhejiang Taizhou Hospital","correspondingAuthor":true,"prefix":"","firstName":"En","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-11-10 03:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5424043/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5424043/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71610811,"identity":"8657e939-3725-4293-9e6d-1ede2f52a33b","added_by":"auto","created_at":"2024-12-17 06:53:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44330,"visible":true,"origin":"","legend":"\u003cp\u003eThe patients screened included all those who underwent EVT for the treatment of acute ischemic stroke due to large vessel occlusion. EVT, endovascular treatment; mTICI, modified thrombolysis in cerebral infarction; mRS, modified Rankin scale\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5424043/v1/977fca4592a28ee82d03aa2b.png"},{"id":79436613,"identity":"c9a79230-af3f-4b15-9b7f-ecb383b77488","added_by":"auto","created_at":"2025-03-28 12:08:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":781398,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5424043/v1/037e21d4-c50e-466a-af58-4173f4ba3d28.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Endovascular treatment beyond 24 hours for large vessel occlusion strokes selected by CT perfusion","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEndovascular treatment (EVT) has revolutionized the management of acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). Multiple high-quality randomized controlled trials have demonstrated the efficacy and safety of EVT in patients who present within 6 hours of their last known well\u003csup\u003e[\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. More recently, the DEFUSE 3 and DAWN trials, which utilized strict inclusion criteria and advanced neuroimaging, demonstrated the superiority of performing EVT for patients who presented within a 6\u0026ndash;24 hour window\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. These findings have shifted the patient selection criteria for EVT from the traditional \u0026ldquo;time window\u0026rdquo; to the \u0026ldquo;tissue window\u0026rdquo;.\u003c/p\u003e \u003cp\u003eCerebral infarction volume expansion occurs at a different pace in different patients\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. In a subset of DEFUSE 3 patients, persistent penumbral tissue was present after 24 hours and was associated with a subsequent increase in infarct volume and worsening of neurological function\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. However, imaging findings of salvageable tissue do not ensure clinical improvement, and potential reperfusion injury and operation-related complications remain a concern. Several studies focusing on the safety and effectiveness of EVT beyond 24 hours from the last known well have demonstrated potentially promising results \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. However, the evidence is limited, especially concerning the use of imaging screening criteria for patients presenting beyond 24 hours after undergoing EVT because of the paucity of high-level studies.\u003c/p\u003e \u003cp\u003eUsing computed tomography (CT) perfusion imaging, we sought to assess the functional and safety outcomes of EVT in patients who presented beyond 24 hours of last known well after strict clinical and imaging screening. We evaluated this possibility by comparing patients who received EVT for more than 24 hours to a matched control group of patients who received EVT in the 6\u0026ndash;24 hour time window. We also aimed to identify the factors associated with good outcomes in patients who underwent EVT for more than 24 hours of last known well.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy population\u003c/p\u003e \u003cp\u003eA retrospective study of patients with AIS who underwent EVT at a single high-volume stroke center between January 2020 and August 2023 was performed. We analysed all patients who underwent EVT beyond 24 hours (very late window) after their last known well time and chose patients who received EVT within the 6\u0026ndash;24 hour (late window) time window as a comparison group. Rescue EVT was performed considering the risk and benefit for patients who presented with mild stroke but experienced neurological deterioration (increased NIHSS score\u0026thinsp;\u0026ge;\u0026thinsp;2) at any time during hospitalization due to LVO \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe 6\u0026ndash;24 hour group was chosen for comparison because it closely resembled the very late group in that there was a greater likelihood of receiving advanced imaging evaluation and a lower likelihood of receiving intravenous thrombolysis before EVT. Patient baseline characteristics, including sex, age, National Institutes of Health Stroke Scale (NIHSS) score before EVT, mismacth volume and artery occlusion site (anterior vs. posterior) were used for propensity score matching. Patients in the very late window group (\u0026gt;\u0026thinsp;24 hours) were matched 1:2 with patients in the 6\u0026ndash;24 hour time window group (nearest neighbour algorithm, with a tolerance of 0.2). Matching was performed without replacement, and unpaired patients who did not meet the matching criteria were excluded. Each PSM-derived pair was created using a full matching algorithms with R package MatchIt. The study was approved by the Institutional Review Board of Taizhou Hospital of Zhejiang Province, Taizhou, China.\u003c/p\u003e \u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: (1) had a stroke onset time or a duration from the last known well to arterial puncture exceeding 6 hours; (2)\u0026thinsp;\u0026ge;\u0026thinsp;18 years of age; (3) had a brain CTP in all patients. For patients with clinical neurological deterioration (ND), CTP was reevaluated after ND. Automatic analysis was performed by RAPID software (iSchema View); for a time window of more than 24 hours: met the following imaging criteria of DEFUSE 3, an ischemic core volume\u0026thinsp;\u0026lt;\u0026thinsp;70 mL,a penumbra volume\u0026thinsp;\u0026ge;\u0026thinsp;15 ml, and an ischemic tissue volume (Tmax\u0026thinsp;\u0026gt;\u0026thinsp;6) to an infarct volume\u0026thinsp;\u0026ge;\u0026thinsp;1.8; for a time window of 6\u0026ndash;24 hours: met the imaging criteria of DEFUSE 3; (4) large vessel occlusion confirmed by CT angiography and clinically confirmed as the responsible lesion of the current stroke; (5) all patients were examined by CT immediately before the intervention, an Alberta Stroke Program Early CT Score (ASPECTS)\u0026thinsp;\u0026ge;\u0026thinsp;6; (6) successful reperfusion at the end of the procedure (modified thrombolysis in cerebral infarction [mTICI] score of 2b to 3). The reasons for unsuccessful reperfusion were complex, including catheter failure to access the lesion due to vascular tortuosity, which was not caused by the stroke itself, and the prognosis of these patients does not reflect the effect of the intervention, so we included only successfully reperfused patients.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: (1) had a modified Ranking Scale (mRS) score\u0026thinsp;\u0026ge;\u0026thinsp;3 before the onset of this stroke; (2) had active bleeding or known signs of obvious bleeding or a history of advanced malignant tumor; (3) were allergic to contrast media or narcotic drugs; (4) had severe damage to liver and kidney function; and (5) had unknown time parameters or missing mRS data at the 90-day follow-up.\u003c/p\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003cp\u003ePatients in both groups underwent EVT, which included mechanical thrombectomy and endovascular angioplasty. Femoral artery puncture was performed after general or local anaesthesia. The microguide wire was used with a microcatheter to pass through the occlusion. Mechanical thrombectomy was administered by the means of direct aspiration via an intermedian catheter, a stent retriever, or a combination. A stent retriever was placed and released in the occlusion section through the microcatheter for 5 minutes and then pulled out of the body, during which the 5F or 6F intermediate catheter continued negative pressure suction. After successful thrombectomy, if the residual stenosis is more than 70% and the distal blood reperfusion is insufficient, or if the residual stenosis segment is reblocked after 10 min of observation, endovascular angioplasty, including balloon dilatation only or with a stent, can be performed in the stenotic segment. Angioplasty was directly utilized for subtotal occlusion. Ten minutes before angioplasty, a loading dose (10 mg/kg) of the glycoprotein IIb/IIIa inhibitor tirofiban was administered through an arterial catheter for 10 minutes. This was followed by intravenous infusion at 0.1 mg/kg/min. This infusion was continued for 24 hours after the operation.. For tandem occlusion, the distal vessels were treated by thrombectomy while the proximal vessels were treated by angioplasty. All patients were examined by CT immediately and 24 hours after the operation.\u003c/p\u003e \u003cp\u003eClinical Outcomes\u003c/p\u003e \u003cp\u003eWe selected functional independence (defined as an mRS ranging from 0\u0026ndash;2) at the 90\u0026thinsp;\u0026plusmn;\u0026thinsp;14 day follow-up after treatment as our primary outcome. We used postprocedural symptomatic intracranial hemorrhage (defined as any intracranial bleeding associated with an increase in the NIHSS score of 4 points from the baseline according to the SITS-MOST\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e definition) and a mortality rate of 90\u0026thinsp;\u0026plusmn;\u0026thinsp;14 days as primary safety outcomes. Additional secondary outcomes included the NIHSS score at discharge, good functional outcome (mRS 0\u0026ndash;1) at 90 days, and other complications (pneumonia, venous thrombus embolism, and gastrointestinal bleeding) at discharge. We also investigated the factors associated with functional independence in patients who underwent EVT more than 24 hours prior.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analyses\u003c/h2\u003e \u003cp\u003eStatistical Package for the Social Sciences (SPSS, version 23.0) software was used for analysis, and all the statistical analyses were carried out at a significance level of 5%. The baseline characteristics of the two groups are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations or medians (interquartile distances) for quantitative data and as the rates or composition ratios for qualitative data. The chi-square test or Fisher exact probability method was used to compare the binary count data, and the group t test or Wilcoxon rank sum test was used to compare the measurement data; Two-way repeated measures ANOVA was used to compare the interaction between the occlusion vessel and time window in subgroup analyses. A two-tailed alpha was used for all analyses. Forward stepwise binary logistic regression (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1) analysis was used to assess which variables predicted good outcome.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eStudy population and baseline characteristics\u003c/p\u003e\n\u003cp\u003eA total of 1116 patients were initially admitted to our stroke center for EVT between January 2020 and August 2023. Of these, 29 patients with missing mRS and CTP data, 5 patients with advanced malignant tumors, 8 patients with unsuccessful reperfusion (mTICI 0-2a) (2 patients presented\u0026thinsp;\u0026gt;\u0026thinsp;24 hours, 6 patients presented 6\u0026ndash;24 hours), and 592 patients treated within 6 hours were excluded (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Eighty-two patients were treated beyond 24 hours, and 400 patients treated at 6\u0026ndash;24 hours after the last known well time were included. The median duration from the last known well-to-puncture for patients receiving EVT beyond 24 hours was 48 hours and ranged from 27\u0026ndash;145 hours. Among them, 34 patients arrived at the hospital within 24 hours of last know well with mild symptoms (the NIHSS score ranged from 0\u0026ndash;3), and were treated with EVT after neurological deterioration during hospitalization. All the other patients had passed the 24-hour time window when they arrived at the hospital.\u003c/p\u003e\n\u003cp\u003eTable 1 shows the baseline clinical information, angiographic findings and procedural technique of the study population stratified based on the time window. After matching, 164 patients were included in the \u0026ldquo;late window\u0026rdquo; group, and 82 patients were included in the \u0026ldquo;very late window\u0026rdquo; group. Patients who were treated with EVT for more than 24 hours had a greater incidence of large-artery atherosclerosis (LAA) (89.0% vs. 75.6%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044), a greater percentage of patients requiring endovascular angioplasty (78.0% vs. 43.7%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a greater percentage of rescue EVT for neurological deterioration patients (85.4% vs. 45.7%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Twelve patients experienced a gradual deterioration and 58 patients experienced a sudden and significant deterioration. All patients underwent rescue EVT within 24 hours of the last deterioration. No significant differences were observed in the remaining baseline clinical or imaging characteristics. The distribution of propensity scores and standardized mean differences before and after matching are presented in Supplemental Figs.\u0026nbsp;1 and table 1 respectively.\u003c/p\u003e\n\u003cp\u003eTable 1. Baseline characteristics of the study population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"569\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9609%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 26.4643%;\"\u003e\n \u003cp\u003eBefore PSM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 26.6431%;\"\u003e\n \u003cp\u003eAfter PSM\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23.9609%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e＞24 hours\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e6-24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e＞24 hours\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e6-24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eAge, median (IQR), y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e67（60-74）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e71（59-78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e67（60-74）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e68（60-74）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eSex(male,n[%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e49（59.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e227（56.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e49（59.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e98（59.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eHypertension (n[%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e57（69.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e249（62.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e57（69.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e97（59.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eDiabetes (n [%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e28（34.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e97（24.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e28（34.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e44（25.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eAtrial fibrillation (n [%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e6（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e113（28.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e＜0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e6（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e26（15.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003ePrior stroke(n[%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e14（17.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e81（20.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e14（17.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e34（20.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003ePrior use of Antiplatelet\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e18（2.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e95（23.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e18（22.0）\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e34（20.7）\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.825\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003epre-stroke mRS(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e0（0-0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e0（0-0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e0（0-0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e0（0-0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.449\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eStroke with exact onset time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e53（64.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e223（55.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e53（64.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e103（62.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eLKW-Puncture time（hour）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e48.63（35.23-70.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e7.79（4.17-12.07）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e48.63（35.23-70.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e11.26（7.87-14.79）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eTOAST classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;LAA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e73（89.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e265（66.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e＜0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e73（89.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e124（75.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.044*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cardioembolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e5（6.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e111（27.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e5（6.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e25（15.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other determined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e3（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e16（4.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e3（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e7（4.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Undetermined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e1（1.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e8（2.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e1（1.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e8（4.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003ePro-operative NIHSS (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e8（7-12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e13（8-17）\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e＜0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e8（7-12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e11（8-13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003ePro-operative mRS (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eIV Thrombolysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e6（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e66（16.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.034*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e6（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e24（14.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003ePro-operative ND\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e70（85.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e125（31.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e70（85.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e75（45.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e＜0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003ePro-operative ASPECTS \u0026nbsp;(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e8（7-9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e9（7-10）\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e8（7-9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e8（7-9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eCTP (IQR, ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eIschemic core volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e1.6（0-7.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e5.3（0-17.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e1.6（0-7.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e4.8（0-15.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eMismacth volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e94（47-125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e40.8（83.3-119.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e94（47-125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e90（46-131）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.617\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eOcclusion site (n [%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eICA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e15（18.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e73（18.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e15（18.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e25（15.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eM1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e35（42.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e167（41.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e35（42.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e75（45.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eM2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e8（9.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e63（15.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e8（9.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e13（7.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eTandem occlusion of anterior circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e3（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e19（4.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e3（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e11（6.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eA1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e3（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e8（2.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e3（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e4（2.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eBA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e9（11.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e45（11.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e9（11.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e22（13.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eV4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e6（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e17（4.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e6（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e9（5.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eTandem occlusion of posterior circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e3（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e8（2.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e3（3.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e5（3.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eTechnique(n[%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eClot retrieval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e18（22.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e278（69.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e＜0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e18（22.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e76（46.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e＜0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eClot retrieval plus angioplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e47（57.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e100（25.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e47（57.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e72（43.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eAngioplasty directly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e17（20.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e22（5.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e17（20.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e16（9.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eStent implantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e17（20.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e53（13.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e17（20.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e26（15.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23.9609%;\"\u003e\n \u003cp\u003eAttempts\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e1.1\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.5898%;\"\u003e\n \u003cp\u003e1.2\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.55%;\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8745%;\"\u003e\n \u003cp\u003e1.1\u0026plusmn;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.7686%;\"\u003e\n \u003cp\u003e1.2\u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.0864%;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: PSM, propensity score matching; IQR, interquartile range; SD, standard deviation; ND, neurological deterioration; CTP, computed tomography perfusion; TOAST, trial of org 10172 in acute stroke treatment; NIHSS, National Institutes of Health Stroke Scale; ICA, intracranial internal carotid artery; M1, M2, segments of middle cerebral artery; A1, segments of anterior cerebral artery; BA, basal artery; V4, segment of vertebral artery; Tandem occlusion, proximal anterior circulation intracranial occlusion with an ipsilateral ICA high-grade stenosis or occlusion, or proximal posterior circulation intracranial occlusion with a vertebral artery high-grade stenosis or occlusion; ND, neurological deterioration; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale. LKW, last known well.\u003c/p\u003e\u003cp\u003eOutcome measures\u003c/p\u003e\n\u003cp\u003eThe clinical and safety outcomes are shown in Table 2. Patients in the very late window had higher NIHSS scores at discharge (4[2-6] vs. 3[1-8]; \u003cem\u003eP\u003c/em\u003e=0.004) but had similar chances of achieving functional independence (mRS 0-2) and good functional outcomes (mRS 0-1) at 90 days than did those in the late window before matching. The safety outcomes, including mortality, symptomatic intracerebral hemorrhage (ICH), asymptomatic ICH, and other complications, were similar between the two groups. After matching, no significant difference was observed in the odds of achieving functional or safety outcomes across the two time windows.\u003c/p\u003e\n\u003cp\u003eTable 2. Clinical and Safety Outcomes in the Study Population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0063%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 31.8038%;\"\u003e\n \u003cp\u003eBefore PSM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 29.9051%;\"\u003e\n \u003cp\u003eAfter PSM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28.0063%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e＞24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e6-24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e＞24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e6-24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003eDischarge NIHSS(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e4（2-6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e5（2-11.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e4（2-6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e3（1-8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003emRS at 90 days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003emRS\u0026le;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e32（39.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e125（31.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e32（39.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e73（44.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003emRS\u0026le;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e48（58.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e187（46.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e48（58.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e101（61.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003eMortality at 90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e6（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e61（15.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e6（7.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e16（9.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003ePostprocedural hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003eSymptomatic ICH\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e2（2.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e19（4.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e2（2.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e5（3.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e0.786\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003eAsymptomatic ICH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e8（9.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e50（12.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e8（9.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e20（12.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e0.570\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.0063%;\"\u003e\n \u003cp\u003eOther complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.0253%;\"\u003e\n \u003cp\u003e37(47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e207（51.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.8608%;\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e37(47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.9177%;\"\u003e\n \u003cp\u003e94(57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.0696%;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: PSM, propensity score matching; ICH, intracranial hemorrhage; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale. \u003csup\u003ea\u003c/sup\u003e, Definition of SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study).criteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFactors predicting good outcomes after EVT for more than 24 hours\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression analysis revealed that the preoperative NIHSS score (OR=0.668, \u003cem\u003eP\u003c/em\u003e=0.002), male sex (OR=5.545, \u003cem\u003eP\u003c/em\u003e=0.020), pro-operative ND (OR=27.192, \u003cem\u003eP\u003c/em\u003e=0.006) were predictors of good outcomes(mRS\u0026le;2) in patients who underwent EVT longer than 24 hours (Table 3). All the other factors, including sex, age, hypertension, diabetes status, atrial fibrillation status, thrombolysis status, last know well-puncture time, pre-stroke mRS, CTP data, treatment technique and occlusion artery were not significantly associated with good prognosis.\u003c/p\u003e\n\u003cp\u003eTable 3. Results of multivariate analysis of factors that are predictive of clinical good outcome in patients who underwent EVT beyond 24 hours\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"431\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eFactor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eSex(male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e5.545(1.720-17.880)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePro-treatment NIHSS score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.668(0.519-0.859)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003epre-stroke mRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.065(0.002-1.981)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePro-operative ND\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e27.192(2.559-288.906)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.006*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePostprocedural hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.061(0.235-4.790)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eSymptomatic ICH\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eAsymptomatic ICH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.996(0.916-1.082)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eHypertension\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.181(0.024-1.333)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eDiabetes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.146(0.223-1.877)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.870\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eAtrial fibrillation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e3.831(0.175-83.791)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eLKW-Puncture time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.999(0.975-1.023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.908\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eocclusion artery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.889(0.117-6.749)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.909\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp; anterior circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eposterior circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003ePro-operative ASPECTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.972(0.469-2.011)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.938\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eCTP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eIschemic core volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.022(0.950-1.100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eMismacth volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.993(0.981-1.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.214\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eTechnique(n[%])\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.081(0.004-1.852)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eClot retrieval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eClot retrieval plus angioplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 163px;\"\u003e\n \u003cp\u003eAngioplasty directly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSubgroup analysis\u003c/p\u003e\n\u003cp\u003eComparisons between anterior and posterior circulation occlusions are shown in Table 4. There was no interaction (\u003cem\u003eP\u003c/em\u003e=0.406) between the location of occlusive vessels (anterior or posterior ) and the time window (6-24 hours or ＞24 hours ) for good outcomes(mRS\u0026le;2). No statistically significant differences were detected in the functional or safety outcomes between the two time window groups for anterior or posterior circulation occlusion. When patients who received EVT beyond 24 hours were analyzed separately, a higher rate of mortality (1.6% vs 27.8%, \u003cem\u003eP\u003c/em\u003e=0.001) was observed in patients with large vessel occlusion in the posterior circulation (Table 5). There was no significant difference in functional outcomes or other safety measures between patients with different occlusion sites.\u003c/p\u003e\n\u003cp\u003eTable 4. Comparison between two time windows of anterior and posterior circulation in matched samples\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"536\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3395%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 34.0416%;\"\u003e\n \u003cp\u003eanterior circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 32.5173%;\"\u003e\n \u003cp\u003eposterior circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e＞24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e6-24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e＞24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e6-24 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.194%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003emRS at 90 days\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003emRS\u0026le;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e27（42.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e61（47.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e5（27.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e12（33.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e0.679\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003emRS\u0026le;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e40（62.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e82（64.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e0.832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e8（44.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e19（52.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e0.564\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003eMortality at 90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e1（1.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e10（7.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e5（27.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e6（15.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003ePostprocedural hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003eSymptomatic ICH\u003csup\u003ea\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e5（3.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e1（5.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e0.333\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003eAsymptomatic ICH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e6（9.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e20（15.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e2（11.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3395%;\"\u003e\n \u003cp\u003eOther complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.8876%;\"\u003e\n \u003cp\u003e27（42.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.3472%;\"\u003e\n \u003cp\u003e64（50.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.6374%;\"\u003e\n \u003cp\u003e0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13.0408%;\"\u003e\n \u003cp\u003e12（66.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.194%;\"\u003e\n \u003cp\u003e30（83.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.4519%;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eICH, intracranial hemorrhage; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e, Definition of SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study).criteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5. Comparison between the anterior and posterior circulation of patients who underwent EVT beyond 24 hours\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"405\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eanterior circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003eposterior circulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003emRS at 90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003emRS\u0026le;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e27（42.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e5(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003emRS\u0026le;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e40（62.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e8(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eMortality at 90 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1（1.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e5(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003ePostprocedural hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eSymptomatic ICH\u003csup\u003ea\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e1(5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eAsymptomatic ICH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e6（9.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e2(11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003eOther complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e27（42.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 122px;\"\u003e\n \u003cp\u003e12(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eICH, intracranial hemorrhage; mRS, modified Rankin scale; NIHSS, National Institutes of Health Stroke Scale. \u003csup\u003ea\u003c/sup\u003e, Definition of SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study).criteria.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eEVT has become the first choice for treating AIS with LVO in the last decade. The DEFUSE-3 and DAWN trials have expanded the time window for this revascularization to 24 hours which allows many more patients to benefit from this procedure. Physiology-based patient selection via identification of an \u0026ldquo;ischemic penumbra\u0026rdquo; via perfusion imaging represents a shift from a strictly time-based patient selection paradigm. The main finding of our study was that EVT performed beyond 24 hours based on CT perfusion evaluation achieved similar odds of functional outcome, mortality and sICH at 90 days compared to those treated between 6 and 24 hours in appropriately selected matched patients caused by large proximal artery occlusion.\u003c/p\u003e\n\u003cp\u003ePrevious data focused on EVT beyond 24 hours are limited. Meta-analyses of pooled rates of functional and safety outcomes showed no significant difference between the \u0026gt;24-hour group and the 6-24-hour group\u003csup\u003e[16,17]\u003c/sup\u003e, and other studies have shown that 90-day outcomes improve when favoring EVT in the 6-24 hour time window\u003csup\u003e[14]\u003c/sup\u003e. These conflicting results may reflect heterogeneity in the selection criteria for this population. The selection of appropriate patients for endovascular therapy through perfusion imaging assessment is the key to obtaining a good prognosis, but the optimal imaging selection criteria for patients beyond the 24-hour window remain uncertain. Only a few small sample studies have established uniform screening criteria for this group of patients. A retrospective study included 21 EVT patients who presented beyond 24 hours but met the DAWN trial imaging criteria, and found that the rates of functional outcomes and sICH were similar to those of the DAWN trial\u003csup\u003e[18]\u003c/sup\u003e. Another propensity score-matched study in Vietnam including 20 EVT patients selected based on the DAWN/DEFUSE 3 imaging criteria also demonstrated similar rates of functional and safety outcomes\u003csup\u003e[19]\u003c/sup\u003e. A single-center study from South Korea comparing outcomes in 61 patients who underwent EVT beyond 24 hours and 104 patients within 6-24 hours demonstrated similar rates of functional independence and sICH based on PWI and DWI mismatch\u003csup\u003e[20]\u003c/sup\u003e. Despite these limitations, these small sample studies demonstrated the feasibility and safety of EVT beyond 24 hours. In our study, the DEFUSE-3 CT perfusion criteria were used to screen patients, which has certain guiding significance for clinical practice.\u003c/p\u003e\n\u003cp\u003eFunctional independence (mRS 0\u0026ndash;2) was achieved in 58.5% of the EVT patients who presented beyond 24 hours, which was greater than that in most studies addressing EVT beyond 24 hours\u003csup\u003e[13.14,15]\u003c/sup\u003e, but the percentage in the 6-24 hours group (61.6%) was comparable to the reported rate in randomized EVT clinical trials of AIS-LVO in 6-24 hours\u003csup\u003e[6-7]\u003c/sup\u003e. There are several potential explanations for these better results. For patients in our study, rigorous imaging criteria, including CT perfusion data and ASPECTS, were used to evaluate the ischemic penumbra, collateral circulation and infarct core to identify patients who may obtain a better prognosis through EVT. Another possible reason is that 89% of patients had large artery atherosclerotic (LAA) occlusion, which was significantly greater than that reported in other studies\u003csup\u003e[13.14.15]\u003c/sup\u003e, and ND occurred in significantly greater proportions of patients who underwent very late EVT. We also found that all patients underwent rescue EVT within 24 hours of the last deterioration, which indicates that salvageable brain tissue may still exist. Patients with LAA and a course of ND right before EVT tend to have better collateral circulation, slower symptom progression, and may achieve greater recovery of neurological function after vascular recanalization.\u003c/p\u003e\n\u003cp\u003eBefore matching, the preoperative NIHSS score in the\u0026nbsp;\u0026gt;24-hour\u0026nbsp;group was significantly lower than that in the 6-24-hour group. The reason may be that patients who undergo EVT beyond 24 hours often have a mild onset of disease, and most patients experience aggravated disease progression during the best drug treatment in the hospital. Doctors are advised to observe changes in the disease in a timely manner, and patients are more receptive to EVT. There was no significant difference in ischemic core volume in different time windows in this study, but we found that it appeared to be much smaller than that in a comparable study\u003csup\u003e[6,7,13]\u003c/sup\u003e. There are several reasons for this phenomenon. First, the proportion of patients with LAA involvement was greater in this study, especially in the \u0026gt;24-hour group, these patients tended to have better collateral circulation, and might have a smaller ischemic core volume. Second, the preoperative NIHSS score of patients with a 6-24 hour time window in this study was lower, which might also be a reason for the small ischemic core. In addition, CT perfusion data form different populations might be different. In another Chinese study, the volume of the ischemic core within 24 hours was similar to that within the 6-24 hour time window in this study\u003csup\u003e[25]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn posterior circulation large vessel occlusion (P-LVO), the rate of functional outcome achievement in patients receiving EVT after 24 hours was similar to that in patients in the 6-24 time window group, but the incidence of mortality was significantly greater. At present, there are very few data on EVT beyond 24 hours with P-LVO. Only one retrospective study included 13 patients with P-LVO and found no significant differences in functional or safety outcomes between these two time windows\u003csup\u003e[14]\u003c/sup\u003e, which is different from the findings of our study. Although the sample size was small, these studies suggest that EVT may be effective for very late EVT in patients with P-LVO, but further studies are needed to evaluate its safety.\u003c/p\u003e\n\u003cp\u003eThis study revealed that men who underwent EVT more than 24 hours prior were more likely to have a good prognosis. Coincidentally, a Korean study of 61 patients in the very late group revealed that male sex was associated with early neurological improvement after EVT\u003csup\u003e[21]\u003c/sup\u003e, which is similar to the results of our study. Another retrospective analysis of a prospective cohort study revealed that women with acute ischemic stroke had worse outcomes, including patient-reported outcomes and functional disability\u003csup\u003e[22]\u003c/sup\u003e. Gender has been considered a confounding factor in most outcome-based studies, and identifying the factors that contribute to sex differences in stroke outcomes may help in the development of personalized stroke prevention and rehabilitation measures. However, due to the small number of patients, the confidence interval for male sex was relatively high, and we look forward to further studies with a larger sample sizes.\u003c/p\u003e\n\u003cp\u003eThis study suggested that the use of CT perfusion imaging to identify patients who may benefit from EVT beyond 24 hours from the last known well may be useful, especially for some large atherosclerosis patients with mild symptoms at the beginning of the disease and neurological deterioration during the course of the disease. Nonetheless, our study has several limitations. First, this was a retrospective and single-center study, and systemic bias could exist as to the selection of appropriate patients for EVT and the timing of this procedure. Second, this was not a case-control study and lacked a comparison to patients treated with best medical therapy only. Third, the small sample size limited the ability to obtain significant statistical results in our analyses of the subgroups and secondary outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, EVT beyond 24 hours appeared to be functional and safe for patients with acute ischemic stroke due to LVO when it met the Deffuse3 imaging criteria. This association was consistent in propensity score-matched cohorts based on clinical characteristics. Patients with neurological deterioration during the course of the disease may be a suitable screening population for super window EVT. Randomized trials assessing the benefits and risks of EVT beyond 24 hours are warranted, and additional efforts are needed to determine the appropriate selection criteria, including clinical and imaging criteria, to identify a potential population of patients who could achieve good functional outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: non\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributors:\u0026nbsp;\u003c/strong\u003eConcept and design: EW, CZW; acquisition, analysis or interpretation of data: WJC, XWW, CZW, FW, WJH, LJC; drafting of the manuscript: CZW, FW; critical revision of the manuscript for important intellectual content: EW,; statistical analysis: CZW, HN; obtained funding: EW, XWW; administrative, technical or material support: EW, FW, WJH, YQJ; supervision: EW.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e: The datasets analyzed in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003eThis study was funded by the Health Science and Technology Program of Zhejiang Provincial (number 2021KY1198 to EW) and Zhejiang Provincial Natural Science Foundation of China ( number LTGY23H090002 to XWW).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by Medical Ethics Committee of Taizhou Hospital of Zhejiang Province. Due to the retrospective nature of the study, Ethics Committee of Taizhou Hospital of Zhejiang Province waived the need of obtaining informed consent. All methods were carried out in compliance with the Helsinki Declaration. All patients\u0026rsquo; information was strictly anonymous and kept confidential in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CT images and intraoperative photographs have obtained the consent of the patients or their legal representatives. The details including the patients themselves have been deleted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eJovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296\u0026ndash;306. doi: 10.1056/NEJMoa1503780. Epub 2015 Apr 17. PMID: 25882510.\u003c/li\u003e\n \u003cli\u003eCampbell BCV, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009\u0026ndash;18. doi: 10.1056/NEJMoa1414792. Epub 2015 Feb 11. PMID: 25671797.\u003c/li\u003e\n \u003cli\u003eBerkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11\u0026ndash;20. doi: 10.1056/NEJMoa1411587. Epub 2014 Dec 17. Erratum in: N Engl J Med. 2015 Jan 22;372(4):394. PMID: 25517348.\u003c/li\u003e\n \u003cli\u003eGoyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019\u0026ndash;30.doi: 10.1056/NEJMoa1414905. Epub 2015 Feb 11. PMID: 25671798.\u003c/li\u003e\n \u003cli\u003eSaver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous rt-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285\u0026ndash;95. doi: 10.1056/NEJMoa1415061. Epub 2015 Apr 17. PMID: 25882376.\u003c/li\u003e\n \u003cli\u003eAlbers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018;378:708\u0026ndash;18.doi: 10.1056/NEJMoa1713973. Epub 2018 Jan 24. PMID: 29364767; PMCID: PMC6590673.\u003c/li\u003e\n \u003cli\u003eNogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018;378:11\u0026ndash;21. doi: 10.1056/NEJMoa1706442. Epub 2017 Nov 11. PMID: 29129157.\u003c/li\u003e\n \u003cli\u003eChristensen S, Mlynash M, Kemp S, et al. Persistent target mismatch profile \u0026gt;24 hours after stroke onset in DEFUSE 3. Stroke. 2019;50(3):754-757. doi:10.1161/STROKEAHA.118.023392\u003c/li\u003e\n \u003cli\u003eSarraj A, Mlynash M, Heit J, et al. Clinical outcomes and identification of patients with persistent penumbral profiles beyond 24 hours from last known well: analysis from DEFUSE 3. Stroke.2021;52(3):838-849. doi:10.1161/STROKEAHA.120.031147\u003c/li\u003e\n \u003cli\u003e.Darby DG, Barber PA, Gerraty RP, et al. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke 1999;30:2043\u0026ndash;52.\u003c/li\u003e\n \u003cli\u003eRocha M, Jovin TG. Fast versus slow progressors of infarct growth in large vessel occlusion stroke. Stroke 2017;48:2621\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eSarraj A, Hassan AE, Abraham M, et al. A randomized controlled trial to optimize patient\u0026rsquo;s selection for endovascular treatment in acute ischemic stroke (SELECT2): study protocol. Int J Stroke 2022;17:689-693.\u003c/li\u003e\n \u003cli\u003eSarraj A, Kleinig TJ, Hassan AE, et al. Association of endovascular thrombectomy vs medical management with functional and safety outcomes in patients treated beyond 24 hours of last known well: the SELECT Late study. JAMA Neurol. 2023;80(2):172-182. doi:10.1001/jamaneurol.2022.4714.\u003c/li\u003e\n \u003cli\u003eShaban A, Al Kasab S, Chalhoub RM, et al. Mechanical thrombectomy for large vessel occlusion strokes beyond 24 hours.J Neurointerv Surg. Published online January 2, 2023. doi:10.1136/jnis-2022-019372\u003c/li\u003e\n \u003cli\u003eHa SH, Ryu JC, Bae JH, et al. Early Response to Endovascular Thrombectomy after Stroke: Early, Late, and Very Late Time Windows. Cerebrovasc Dis. 2023;52(1):28-35. doi: 10.1159/000525083. Epub 2022 Jun 7. PMID: 35671740.\u003c/li\u003e\n \u003cli\u003eKobeissi H, Ghozy S, Adusumilli G, et al. Endovascular Therapy for Stroke Presenting Beyond 24 Hours: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023 May 1;6(5):e2311768. doi: 10.1001/jamanetworkopen.2023.11768. PMID: 37140919; PMCID: PMC10160871.\u003c/li\u003e\n \u003cli\u003eRodriguez-Calienes A, Galecio-Castillo M, Vivanco-Suarez J, et al. Endovascular thrombectomy beyond 24 hours from last known well: a systematic review with meta-analysis. J Neurointerv Surg. 2023 Jun 24:jnis-2023-020443. doi: 10.1136/jnis-2023-020443. Epub ahead of print. PMID: 37355251.\u003c/li\u003e\n \u003cli\u003eDesai SM, Haussen DC, Aghaebrahim A, et al. Thrombectomy 24 hours after stroke: beyond DAWN. J Neurointerv Surg. 2018 Nov;10(11):1039-1042. doi: 10.1136/neurintsurg-2018-013923. Epub 2018 May 28. PMID: 29807887.\u003c/li\u003e\n \u003cli\u003eCasetta I, Fainardi E, Pracucci G, et al; Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS). Endovascular treatment beyond 24 hours from the onset of acute ischemic stroke: the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS). J Neurointerv Surg. 2022 Dec;14(12):1186-1188. doi: 10.1136/neurintsurg-2021-018045. Epub 2021 Nov 3. PMID: 34732532.\u003c/li\u003e\n \u003cli\u003eHa SH, Ryu JC, Bae JH, et al. Early Response to Endovascular Thrombectomy after Stroke: Early, Late, and Very Late Time Windows. Cerebrovasc Dis. 2023;52(1):28-35. doi: 10.1159/000525083. Epub 2022 Jun 7. PMID: 35671740.\u003c/li\u003e\n \u003cli\u003eHa SH, Ryu JC, Bae JH, et al. Early Response to Endovascular Thrombectomy after Stroke: Early, Late, and Very Late Time Windows. Cerebrovasc Dis. 2023;52(1):28-35. doi: 10.1159/000525083. Epub 2022 Jun 7. PMID: 35671740.\u003c/li\u003e\n \u003cli\u003eOliveira LC, Ponciano A, Tuozzo C, et al. Poststroke Disability: Association Between Sex and Patient-Reported Outcomes. Stroke. 2023 Feb;54(2):345-353. doi: 10.1161/STROKEAHA.122.041502. Epub 2023 Jan 23. PMID: 36689580.\u003c/li\u003e\n \u003cli\u003eWahlgren N, Ahmed N, D\u0026aacute;valos A, et al; SITS-MOST investigators. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke\u0026ndash;Monitoring Study (SITS-MOST): an observational study. Lancet. 2007;369(9558): 275-282. doi:10.1016/S0140-6736(07)60149-4. PMID: 17258667.\u003c/li\u003e\n \u003cli\u003eRocha M, Jovin TG. Fast versus slow progressors of infarct growth in large vessel occlusion stroke: clinical and research implications. Stroke 2017;48:2621\u0026ndash;7.doi: 10.1161/STROKEAHA.117.017673. Epub 2017 Aug 9. PMID: 28794271.\u003c/li\u003e\n \u003cli\u003eCao Z, Wang D, Feng X, et al. Assessment of Perfusion Volumes by a New Automated Software for Computed Tomography Perfusion. Stroke Vasc Neurol. 2024 Mar 28:svn-2023-002964. doi: 10.1136/svn-2023-002964. Epub ahead of print. PMID: 38548327.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5424043/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5424043/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe role that endovascular treatment (EVT) may play in stroke patients with large vessel occlusion (LVO) who are treated beyond 24 hours after onset is unclear. In this study, we aimed to examine the efficacy and safety of EVT beyond 24 hours based on uniform CT perfusion criteria in appropriately selected patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective review was performed at a single stroke center between January 2020 and August 2023. We chose patients who received EVT beyond 24 hours via CT perfusion. A matched group of patients who received EVT within the 6\u0026ndash;24 hour time window was chosen as a control. Functional independence (modified Rankin scale score\u0026thinsp;\u0026le;\u0026thinsp;2) at 90 days was used as the primary outcome, and symptomatic intracranial hemorrhage (sICH)and mortality were considered safety outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe selected 400 patients treated with EVT within the 6\u0026ndash;24 hour time window and 82 patients treated beyond 24 hours. A 2:1 matched group was used for comparison. No significant differences in functional independence (58.5% vs. 61.6%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.645), safety outcomes of sICH (7.3% vs. 9.8%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.527), or mortality (2.4% vs. 3.0%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.786) at 90 days were demonstrated. Patients who underwent EVT beyond 24 hours had a greater incidence of large-artery atherosclerosis (LAA) (89.0% vs. 75.6%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044) and a course of neurological deterioration before EVT (78.0% vs. 43.7%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). According to multivariate analysis, the preoperative NIHSS score (OR\u0026thinsp;=\u0026thinsp;0.770, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), sex (OR\u0026thinsp;=\u0026thinsp;4.569, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), and pro-operative ND (OR\u0026thinsp;=\u0026thinsp;27.192, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006) were associated with good outcomes.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCompared with endovascular treatment performed within the 6\u0026ndash;24 hours, EVT beyond 24 hours appears to be feasible and safe for acute LVO stroke patients who meet the DEFUSE-3 imaging criteria based on CT perfusion. Patients with neurological deterioration during the course of the disease may be a suitable screening population for super late window EVT.\u003c/p\u003e","manuscriptTitle":"Endovascular treatment beyond 24 hours for large vessel occlusion strokes selected by CT perfusion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 06:37:18","doi":"10.21203/rs.3.rs-5424043/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54fd4842-c868-4470-9f06-af25298c895f","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-28T12:08:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-17 06:37:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5424043","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5424043","identity":"rs-5424043","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}