Endovascular treatment guided by tissue window rather than time window may be safe and feasible in patients with ischemic stroke

Abstract

For progressive stroke caused by large vessel occlusion (LVO) beyond the 24-hour time window, dedicated evidence for endovascular treatment (EVT) remains scarce, and there is currently no established treatment standard. We investigated the safety and feasibility of tissue window-guided EVT in this ultra-late window population. A retrospective cohort study was adopted, enrolling patients with LVO undergoing EVT beyond 24 h of symptom onset. All patients presented with initial minor stroke, subsequent neurological deterioration, and imaging-confirmed salvageable ischemic penumbra. Twenty-one patients were enrolled, with a median time of 39 h from onset to puncture. The successful recanalization rate was 95.2%, with 71.4% of patients achieving complete recanalization. No mortality or symptomatic intracranial hemorrhage occurred. 47.6% of patients exhibited significant early neurological improvement, and 28.6% achieved functional independence at discharge. Our data support the technical feasibility of EVT for carefully selected patients with progressive stroke and salvageable penumbra beyond the standard time window. Not applicable.