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Outcomes of Witnessed Versus Unwitnessed Patients With Stroke After Endovascular Therapy in the Extended Time Window
Journal article   Open access   Peer reviewed

Outcomes of Witnessed Versus Unwitnessed Patients With Stroke After Endovascular Therapy in the Extended Time Window

Liisa Tomppo, Nicolas Martinez-Majander, Muhammad M Qureshi, Thanh N Nguyen, Raul G Nogueira, Simon Nagel, Jelle Demeestere, Volker Puetz, Hilde Henon, Marta Olive-Gadea, …
Stroke (1970), Vol.57(2), pp.362-370
02/2026
DOI: 10.1161/STROKEAHA.125.052355
PMCID: PMC12829500
PMID: 41221581
url
https://lirias.kuleuven.be/retrieve/fb675fab-6937-467f-b7dd-3e7af5c4ea07View
Open Access

Abstract

It remains unclear whether outcomes of patients treated with endovascular thrombectomy with large-vessel occlusion and unwitnessed onset of stroke differ from those with witnessed onset in the extended time window. We enrolled patients with anterior circulation large-vessel occlusion (internal carotid artery, M1, or M2 segment of the middle cerebral artery) undergoing endovascular thrombectomy within 6 to 24 hours from the time last seen well, from 2014 to 2022, at 66 sites in Europe, North America, and Asia. Patients with a prestroke modified Rankin Scale score of >3 or age <18 were excluded. We categorized patients by onset mode as witnessed or unwitnessed. The primary outcome was the modified Rankin Scale shift at 90 days. Secondary outcomes were functional independence, a composite of functional independence or return of Rankin to prestroke level, symptomatic intracranial hemorrhage, mortality, and a composite of severe disability or mortality at 90 days. We applied inverse probability of treatment weighting to compare outcomes between the groups. Of 5098 patients assessed for eligibility, we included 2073, of whom 1760 (84.9%) had unwitnessed onset, and 313 (15.1%) were witnessed. In the univariate comparison (before inverse probability of treatment weighting), 38.8% of the unwitnessed and 45.7% of the witnessed patients achieved functional independence ( =0.022). Mortality was 21.6% among unwitnessed and 22.0% among witnessed ( =0.847), and symptomatic intracranial hemorrhage rates were 6.6% and 5.8%, respectively ( =0.623). The primary outcome (modified Rankin Scale shift) showed no difference comparing unwitnessed to witnessed patients (odds ratio, 1.35 [95% CI, 0.82-2.20]; =0.235) in the inverse probability of treatment weighting. Unwitnessed patients were more likely to achieve functional independence or return of Rankin (1.53 [1.01-2.33]; =0.045). Other secondary outcomes did not differ between the witnessed and unwitnessed patients. In the extended time window, unwitnessed patients with large-vessel occlusion undergoing endovascular thrombectomy have at least the same likelihood of favorable outcomes as witnessed patients. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04096248.
 intracranial hemorrhage thrombectomy tomography ischemic stroke middle cerebral artery

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