May 10, 2026 · Lancet (London, England) · DOI: 10.1016/S0140-6736(26)00876-7

Endovascular thrombectomy for patients with large-core ischaemic stroke presenting up to 24 h after onset (ATLAS): a systematic review and individual patient data meta-analysis with central imaging adjudication

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The authors aimed to evaluate the efficacy and safety of endovascular thrombectomy in patients with large-core ischaemic stroke presenting within 24 hours of onset, a group often excluded from such treatments. Their systematic review and meta-analysis of individual patient data from six trials found that endovascular thrombectomy significantly improved functional outcomes and reduced mortality compared to medical management, although the benefits were less clear for patients with very large ischaemic core volumes (≥150 mL). Overall, the findings suggest that endovascular thrombectomy is beneficial for most patients with large-core ischaemic strokes, except in cases of extensive ischaemic changes presenting beyond 6 hours.

Amrou Sarraj, Götz Thomalla, Shinichi Yoshimura, Xiaochuan Huo, Vincent Costalat, Osama O Zaidat, Caroline Arquizan, Hannah Johns, Vignan Yogendrakumar, Leonid Churilov, Deep Pujara, Clark W Sitton, David S Liebeskind, Manabu Inoue, Charles Majoie, Ludo Beenen, Mohammad Ammar Abdulrazzak, Aditya Chaturvedi, Sarthak Singh, Mark W Parsons, Angelique Denis, Nobuyuki Sakai, Thanh N Nguyen, Jean François Albucher, Sami Al Kasab, Ameer E Hassan, Michael Abraham, Ansar Rai, Hilde Henon, Dapeng Sun, Hiroshi Yamagami, Fabien Subtil, Susanne Bonekamp, Kazutaka Uchida, Guangxiong Yuan, Benjamin Gory, Wade Smith, Santiago Ortega-Gutierrez, Spiros Blackburn, Sunil A Sheth, Gaultier Marnat, Liping Liu, Manabu Shirakawa, Jens Fiehler, Märit Jensen, Seigo Shindo, Raul G Nogueira, Ramesh Grandhi, Pascal Jabbour, Muhammad Shazam Hussain, Diederik Dippel, Yilong Wang, Yukako Yazawa, Claus Z Simonsen, Yongjun Wang, Michael Chen, Michael D Hill, James C Grotta, Bertrand Lapergue, Tudor G Jovin, Albert J Yoo, Martin Bendszus, Bruce C V Campbell, Takeshi Morimoto, Zhongrong Miao, ATLAS Investigators

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May 6, 2026 · The New England journal of medicine

Dr. Jennifer Thompson

Portland, OR

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Endovascular thrombectomy for patients with large-core ischaemic stroke presenting up to 24 h after onset (ATLAS): a systematic review and individual patient data meta-analysis with central imaging adjudication

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