Time to Treatment in Stroke Thrombectomy and Outcomes in the Extended Time Window: A Meta-Analysis.

Its impact in the extended (6-24-hour) window remains uncertain.

在延长的（6-24小时）时间窗口内，其（EVT）的影响仍然不确定。

We aimed to evaluate the association between treatment times and outcomes in this window.

我们旨在评估治疗次数与该时间窗内结果之间的关联。

Methods

Individual patient-level data from 6 randomized trials enrolling patients in the extended window were pooled.

从6项纳入延长窗口期患者的随机试验中，合并了个体患者级别的数据。

The primary outcome was degree of disability at 90 days (modified Rankin Scale [mRS] 0-6).

主要结果是90天时的残疾程度（改良Rankin量表[mRS] 0-6）。

Secondary outcomes included functional independence (mRS 0-2), mortality, and symptomatic intracranial hemorrhage.

次要结果包括功能独立性（mRS 0-2）、死亡率和症状性颅内出血。

Results

Among 505 participants (median age 70 years; baseline NIH Stroke Scale 16; 51.3% female; advanced imaging selection 86.5%), 266 (52.7%) received EVT and 239 (47.3%) medical therapy alone.

在505名参与者中（中位年龄70岁；基线NIH中风量表评分为16；女性占51.3%；高级影像选择86.5%），266人（52.7%）接受了EVT治疗，而239人（47.3%）仅接受了药物治疗。

In EVT-treated patients, longer onset-to-randomization times were not associated with differences in disability (adjusted odds ratio [aOR] per 60 minutes 1.02; 95% CI 0.96-1.08; p = 0.53) or functional independence (aOR 1.06; 95% CI 0.95-1.17; p = 0.28).

在接受EVT治疗的患者中，发病至随机化时间的延长与残疾程度（调整后优势比[aOR]每60分钟1.02；95%置信区间0.96-1.08；p = 0.53）或功能独立性（aOR 1.06；95%置信区间0.95-1.17；p = 0.28）的差异无关。

Conversely, control patients exhibited worse outcomes with increasing onset-to-randomization times (aOR for disability 0.93; 95% CI 0.87-1.00; p = 0.041; functional independence 0.84; 95% CI 0.73-0.97; p = 0.019), resulting in greater treatment benefit at later times (p-interaction = 0.033 and 0.003, respectively).

相反地，对照组患者随着发病至随机化时间的增加显示出更差的结果（残疾的调整后比值比为0.93；95%置信区间0.87-1.00；p = 0.041；功能独立性的调整后比值比为0.84；95%置信区间0.73-0.97；p = 0.019），导致在较晚的时间点上治疗益处更大（p-交互作用分别为0.033和0.003）。

No association was observed between onset-to-puncture or onset-to-reperfusion and outcomes in EVT patients.

在EVT患者中，未观察到发病至穿刺或发病至再灌注与结果之间的关联。

However, longer randomization-to-reperfusion times correlated with worse disability (aOR 0.58; 95% CI 0.37-0.91; p = 0.018) and lower functional independence (aOR 0.51; 95% CI 0.28-0.96; p = 0.038).

然而，更长的随机化至再灌注时间与更差的残疾程度相关（调整比值比aOR 0.58; 95% 置信区间CI 0.37-0.91; p = 0.018）以及较低的功能独立性（调整比值比aOR 0.51; 95% 置信区间CI 0.28-0.96; p = 0.038）。

Discussion

This study demonstrates that the benefit of EVT is consistently preserved across the extended (6-24-hour) time window when patients are selected using advanced imaging criteria.

本研究证明，当使用高级影像学标准选择患者时，血管内治疗（EVT）的好处在6-24小时的延长治疗时间窗口内是一致的。

In this highly selected population, enriched with slow progressors, the apparent increase in treatment effect with longer onset-to-presentation times reflects the validity of physiologic selection rather than true time insensitivity.

在这群高度筛选的患者中，由于富集了缓慢进展者，随着发病到就诊时间的延长，治疗效果的明显增加反映了生理选择的有效性，而不是真正的时间不敏感性。

However, this observation should not diminish the critical importance of time: imaging-based selection effectively resets the treatment clock, masking the harmful impact of prehospital delays.

然而，这一观察不应减少时间的关键重要性：基于影像的选择有效地重置了治疗时钟，掩盖了院前延误的有害影响。

Notably, longer in-hospital delays were strongly associated with worse outcomes, reinforcing that "time is brain," even in extended-window cohorts.

值得注意的是，住院延迟时间较长与较差的结果有强烈的关联性，这进一步强化了“时间就是大脑”的观点，即使在扩展窗口期队列中也是如此。