A retrospective analysis of a prospectively maintained thrombectomy database across 3 centers. Demographic, clinical, and outcomes data were analyzed. Inclusion criteria were witnessed onset LVO [internal carotid/middle cerebral artery-M1] strokes with baseline mRS score 0-1 having achieved mTICI 2b-3 recanalization and 24-hour infarct volume of ≤10 ml on CT head/MRI. Multivariate analysis of the impact of time to recanalization on outcomes was performed.

Of 499 LVO strokes undergoing thrombectomy, 30% (148) met criteria. Mean age was 70 ±14 and median NIHSS was 17 (14-21). Early recanalization (<6h) was achieved in 65% (96) of patients. Baseline demographic (age: 73 vs 74,p=0.80)  and clinical characteristics (NIHSS:16.5 vs 17,p=0.52; 24-h infarct volume: 4.4 vs 4.2 ml,p=0.60) were comparable between early versus late recanalizers. Rates of early clinical improvement (24-h NIHSS <6) (71% vs 39%,p=0.0007) and 90-day mRS 0-2 (68% vs 48%,p=0.019) were higher in early recanalizers. Early recanalization was an independent predictor of 90-day mRS 0-2 (OR-2.41 95%-CI 1.89-4.50). Every 1-hour increase in time to recanalization decreased the odds of 90-day mRS 0-2 by 2.2%.

Among patients with similar 24-hour infarct volume post thrombectomy (≤10 ml), shorter time to successful recanalization is associated with significantly higher rates of early clinical improvement and 90-day mRS 0-2. Increased penumbral ischemic time may have an impact on outcomes post thrombectomy.