Thrombectomy 24 to 72 hours after stroke: better function, more haemorrhage and death

Design

Open-label randomised trial, blinded outcome assessment (LATE-MT)

Population

336 patients with anterior large-vessel stroke and salvageable tissue at 24–72 hours

Primary outcome

Modified Rankin distribution at 90 days

Effect

Common OR 1.74 (1.19–2.55); symptomatic ICH 4.8% vs 0%; deaths 6.0% vs 1.8%

LATE-MT was an open-label trial with blinded outcome assessment at Chinese comprehensive stroke centres. It randomised 336 patients with anterior-circulation large-vessel occlusion and imaging-defined salvageable tissue, presenting 24 to 72 hours after onset or last seen well (median 38.5 hours), to thrombectomy plus medical care or medical care alone.

Thrombectomy shifted the 90-day modified Rankin distribution towards better function (common odds ratio 1.74, 95% CI 1.19 to 2.55). It also carried real harm: symptomatic intracranial haemorrhage in 4.8% against none, and 90-day deaths of 6.0% against 1.8%.

This extends the selection-by-imaging logic beyond the current 24-hour window, but the trade-off is sharper than in earlier late-window trials. It is a single-country trial; guidelines still set 24 hours as the outer limit. For clinicians outside stroke, the message is practical: a patient found a day or two after a stroke may still be worth discussing urgently with a stroke centre if perfusion imaging is available.

• Discuss patients with large-vessel stroke presenting after 24 hours with a stroke centre rather than assuming they are too late.
• Selection depended on perfusion imaging showing salvageable tissue, not on time alone.
• Explain the trade-off: better average function, but symptomatic haemorrhage about 5% and more deaths.
• Guidelines have not changed; late-window thrombectomy beyond 24 hours remains a specialist decision.

Why it matters

It challenges the assumption that a stroke discovered the next morning is beyond intervention.

Don't overread it

One open-label trial from one country, with excess deaths, does not yet establish 72 hours as a treatment window.

The statistics, in plain English

A common odds ratio of 1.74 means that across the whole disability scale, thrombectomy patients were about 1.7 times as likely to be in a better category. The interval excludes 1, so the functional benefit is unlikely to be chance — but the higher death rate means some patients were harmed.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.