Endovascular Thrombectomy Performed 30 Hours After Onset of Acute Ischemic Stroke with Excellent Clinical Outcome

The benefits of endovascular thrombectomy (EVT) performed within a 24-h window in patients with acute ischemic stroke (AIS) have been demonstrated in several international trials, and its usefulness is accepted and reflected in clinical recommendations. However, the safety and efficacy of EVT >24 h after clinical stroke onset are poorly understood. Selection for transcatheter revascularization in patients presenting >24 h after stroke onset should be based on neuroimaging data. In a limited number of patients with a small infarct core and a sufficiently large penumbra (i.e., salvageable brain tissue), EVT may be useful even >24 h after clinical stroke onset. We present the clinical case of an AIS patient who underwent successful EVT approximately 30 h after clinical onset. Selected patients, especially those with competent leptomeningeal collaterals or nonocclusive emboli, may benefit from (very) late thrombectomy of large intracranial vessel occlusions.