LATE-MT
(2026)Objective
To evaluate whether mechanical thrombectomy plus best medical management improves 90-day functional outcome versus best medical management alone in anterior-circulation large vessel occlusion stroke patients presenting in the very late time window (24–72 hours from last known well) with favorable perfusion imaging.
Study Summary
• Functional independence at 90 days (mRS 0–2) was higher with EVT (48.5% vs 36.3%) and benefits extended to utility-weighted mRS, Barthel Index, and quality-of-life scores.
• Safety was worse with thrombectomy: any ICH 28.3% vs 5.5%, sICH 4.8% vs 0%, and numerically higher 90-day mortality (6.0% vs 1.8%).
• LATE-MT extends the thrombectomy window to 24–72 hours for carefully selected slow-progressor patients, but the benefit comes with a meaningful hemorrhagic and mortality trade-off.
Intervention
Mechanical thrombectomy (EVT) plus best medical management vs. best medical management alone
Inclusion Criteria
Acute ischemic stroke from anterior-circulation LVO (ICA-EC, ICA-IC, M1, or M2 occlusion); 24–72 hours from last known well; NIHSS ≥6; perfusion mismatch on imaging (ischemic core <50 mL, mismatch ratio ≥1.8, mismatch volume ≥15 mL). Multicenter trial conducted in China; adaptive PROBE design; randomization stratified by 24–48h vs 48–72h time window.
Study Design
Arms: EVT + best medical management vs. best medical management alone
Patients per Arm: EVT n=168 vs BMM n=168 (total 341 randomized)
Outcome
• 90-day mRS 0–2: 48.5% vs 36.3% (favors EVT).
• Any ICH: 28.3% vs 5.5% (significant).
• Symptomatic ICH: 4.8% vs 0%.
• 90-day mortality: 6.0% vs 1.8% (numerically higher with EVT).
• Serious adverse events: 22% vs 13.1%; adverse events of special interest: 15.5% vs 8.9%.
• 7-day follow-up infarct volume: 23 mL vs 23 mL (comparable).
• Subgroup signal: greater benefit in patients with ICA occlusions.