Thrombectomy beyond 24 hours: better function at 90 days, but more bleeds and deaths

Design

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

Population

336 patients with anterior large-vessel occlusion stroke and salvageable tissue, 24 to 72 hours from last known well

Primary outcome

Modified Rankin scale distribution at 90 days

Effect

Common OR 1.74 (95% CI 1.19 to 2.55); symptomatic haemorrhage 4.8% vs 0%; death 6.0% vs 1.8%

LATE-MT was an open-label randomised trial with blinded outcome assessment at Chinese comprehensive stroke centres. It enrolled 336 patients with an anterior-circulation large-vessel occlusion and salvageable brain tissue on imaging, 24 to 72 hours after they were last known well; the median was 38.5 hours. Patients received thrombectomy plus medical care or medical care alone.

Thrombectomy shifted 90-day disability scores towards better function (common odds ratio 1.74, 95% CI 1.19 to 2.55). It also caused symptomatic intracranial haemorrhage in 4.8%, against none with medical care, and 90-day death was 6.0% against 1.8%.

The finding extends the reach of thrombectomy to patients who arrive a day or more late, provided imaging shows tissue still worth saving. That matters most where late presentation is common, as it is across much of India. The trade-off is real and has to be part of the conversation with families. Guidelines have not yet been revised, and the result needs confirming outside China.

• Do not exclude a patient from stroke team review because more than 24 hours have passed.
• Arrange urgent CT or MR perfusion imaging where a large-vessel occlusion is suspected late.
• Discuss the higher bleeding and death risk with families alongside the functional benefit.
• Expect selection to depend on salvageable tissue on imaging, not on the clock alone.

Why it matters

The patient who arrives the day after a stroke has usually been told it is too late.

Don't overread it

One open-label trial from one country; guidelines have not yet changed.

The statistics, in plain English

A common odds ratio of 1.74 means that, across every level of the disability scale, patients who had thrombectomy had about 1.7 times the odds of being in a better category. The interval (1.19 to 2.55) excludes no effect. The excess deaths (6.0% against 1.8%) are small numbers in 168 patients per group, so the size of that harm is uncertain, but its direction is clear.

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