Time to Treatment in Stroke Thrombectomy and Outcomes in the Extended Time Window

作者：Raul G. Nogueira, Tudor G. Jovin, Maarten G. Lansberg, Diogo C Haussen, Ashutosh P. Jadhav, Scott Brown, Marc Ribó, Sheila Cristina Ouriques Martins, Francisco J. Mont'Alverne, Michael D. Hill, Mayank Goyal, Mohamed Fahmy Doheim, J.D. Mocco, David S. Liebeskind, Jeremy J. Heit, Michael P. Marks, Gregory W. Albers, for the AURORA Collaborators, Andrew M. Demchuk, Santiago Ortega-Gutierrez, Fabricio O. Lima, Adnan H. Siddiqui, Bijoy K. Menon, Stephanie Kemp, Ron Budzik, Xabier Urra, Vincent Costalat · 发表于：Neurology · 年份：2026 · DOI：10.1212/wnl.0000000000218113 · 被引用次数：1 · 研究领域：Acute Ischemic Stroke Management、Venous Thromboembolism Diagnosis and Management、Intracerebral and Subarachnoid Hemorrhage Research

BACKGROUND AND OBJECTIVES: Time to endovascular thrombectomy (EVT) is a critical determinant of outcomes for large vessel occlusion (LVO) strokes presenting within 6 hours of onset. Its impact in the extended (6-24-hour) window remains uncertain. We aimed to evaluate the association between treatment times and outcomes in this window. METHODS: Individual patient-level data from 6 randomized trials enrolling patients in the extended window were pooled. The primary outcome was degree of disability at 90 days (modified Rankin Scale [mRS] 0-6). Secondary outcomes included functional independence (mRS 0-2), mortality, and symptomatic intracranial hemorrhage. RESULTS: = 0.038). DISCUSSION: This study demonstrates that the benefit of EVT is consistently preserved across the extended (6-24-hour) time window when patients are selected using advanced imaging criteria. In this highly selected population, enriched with slow progressors, the apparent increase in treatment effect with longer onset-to-presentation times reflects the validity of physiologic selection rather than true time insensitivity. However, this observation should not diminish the critical importance of time: imaging-based selection effectively resets the treatment clock, masking the harmful impact of prehospital delays. Notably, longer in-hospital delays were strongly associated with worse outcomes, reinforcing that "time is brain," even in extended-window cohorts.