WSO - March 2024 - 312

312
International Journal of Stroke 19(3)
population where, in the absence of a good pre-hospital
paramedical triage system, there is a considerable delay in
the acute stroke workflow, and therefore, the number of
patients eligible for EVT beyond 24 h could be higher compared
to a developed country. In contrast to developed
regions, our population has a high rate of intracranial atherosclerosis26
which may limit the generalizability of the
study. However, recent meta-analysis supports our findings
across different ethnicities.27
Our study has limitations. First, there are limitations due
to its retrospective nature and small sample size. Second,
when compared with the 6- to 24-h group, there was a lack
of statistical significance, and thus, our findings need to be
confirmed in larger studies. Third, it involves an indirect
comparison that implies the safety and efficacy of >24 h
thrombectomy by comparing it with 6- to 24-h thrombectomy,
lacking a comparison to best medical treatment.
Fourth, the LVO etiology in our study differs from that in
developed countries. Fifth, our study was conducted in a
clinical setting where a good pre-hospital paramedical triage
system was absent, and there was a considerable delay
in the acute stroke workflow in the tertiary hospital.
Consequently, the number of patients eligible for EVT
beyond 24 h could be higher than in developed countries,
which may limit the generalizability of our results to other
studies. Sixth, as we did not use non-contrast computed
tomography (NCCT) modality only in the selection of
patients for EVT by parenchymal imaging, we do not know
if our findings are applicable to centers who do not routinely
use perfusion to select patients in the late window.28
Nevertheless, our findings provide critical evidence for the
continued treatment of stroke patients beyond 24 h from
symptom onset. Randomized controlled trials are needed to
confirm the superiority of EVT over conservative treatment
in the very late window.
Conclusion
Our study conducted in a developing country suggests that
EVT may be performed safely and effectively in LVO
patients beyond 24 h from symptom onset selecting by target
mismatch profile.
Acknowledgements
The authors express their gratitude to the staff at the Department
of Cerebrovascular Diseases and the Department of
Neurointervention, 115 People's Hospital, who treated the patients
and provided the data for this study. The authors also acknowledge
the support of the Grant and Innovation Center at the
University of Medicine and Pharmacy in Ho Chi Minh City for
this research.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
International Journal of Stroke, 19(3)
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article:
T.Q.N. was funded by the PhD Scholarship Programme of
Vingroup Innovation Foundation (VINIF), code VINIF.2023.
TS.139.
Data availability
The data sets generated during and/or analyzed during the study
are available from the corresponding author on reasonable request
after ethics clearance and approval by all authors.
ORCID iDs
Trung Quoc Nguyen
Hai Ngoc Phung
Hang T Minh Tran
Thanh N Nguyen
https://orcid.org/0000-0003-1091-9320
https://orcid.org/0000-0003-1533-8074
https://orcid.org/0009-0000-0321-8863
https://orcid.org/0000-0002-2810-1685
Supplemental material
Supplemental material for this article is available online.
References
1. Goyal M, Demchuk AM, Menon BK, et al. Randomized
assessment of rapid endovascular treatment of ischemic
stroke. N Engl J Med 2015; 372: 1019-1030.
2. 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.
3. 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: 708-718.
4. Rocha M and Jovin TG. Fast versus slow progressors of
infarct growth in large vessel occlusion stroke: clinical and
research implications. Stroke 2017; 48: 2621-2627.
5. Vagal A, Aviv R, Sucharew H, et al. Collateral clock is more
important than time clock for tissue fate. Stroke 2018; 49:
2102-2107.
6. 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: 172-182.
7. Purrucker JC, Ringleb PA, Seker F, et al. Leaving the day
behind: endovascular therapy beyond 24 h in acute stroke of
the anterior and posterior circulation. Ther Adv Neurol Disord
2022; 15: 17562864221101083.
8. 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: 838-849.
9. Yaghi S, Raz E, Dehkharghani S, et al. Penumbra consumption
rates based on time-to-maximum delay and reperfusion
status: a post hoc analysis of the DEFUSE 3 trial. Stroke 2021;
52: 2690-2693.
10. Kim BJ, Menon BK, Kim JY, et al. Endovascular treatment
after stroke due to large vessel occlusion for patients presenting
very late from time last known well. JAMA Neurol 2020;
78: 21-29.
https://www.orcid.org/0000-0003-1091-9320 https://www.orcid.org/0000-0003-1533-8074 https://www.orcid.org/0009-0000-0321-8863 https://www.orcid.org/0000-0002-2810-1685
WSO - March 2024

Table of Contents for the Digital Edition of WSO - March 2024
