Jovin TG, Nogueira RG, Lansberg MG, et al. - Patients considered to have salvageable brain tissue were recruited in trials examining the advantages of thrombectomy in anterior circulation proximal large vessel occlusion stroke, and depending on study protocol, were assigned beyond 6 h and up to 24 h from time last seen well. In this study, the benefit of thrombectomy was determined overall and in prespecified subgroups through individual patient data meta-analysis.

• Of 17 screened published randomized trials, six trials met inclusion criteria and yielded data of 505 individuals (n = 266 intervention, n = 239 control; mean age 68·6 years [SD 13·7], 259 [51·3%] women) for inclusion.

• Thrombectomy was identified as beneficial with an unadjusted common odds ratio (OR) of 2·42 and an adjusted common OR (for age, gender, baseline stroke severity, extent of infarction on baseline head CT, and time from onset to random assignment) of 2·54.

• Higher rates of independence in activities of daily living (mRS 0–2) were recorded in correlation with undergoing thrombectomy vs receiving best medical therapy alone (122 [45·9%] of 266 vs 46 [19·3%] of 238).

• Overall endovascular thrombectomy is suggested as beneficial for cases with evidence of reversible cerebral ischemia across the 6–24 h time window.

• Researchers recommend not withholding thrombectomy on the basis of mode of presentation or of the point in time of presentation within the 6–24 h time window.