Thrombectomy’s eligibility window keeps widening — and imaging is the gatekeeper.
For most of stroke’s history, the binding constraint was the clock. That’s changing. At the European Stroke Organisation Conference 2026, three lines of evidence converged on the same idea — patients should be selected by what their imaging shows, not by how late they present:
ATLAS (meta-analysis of 6 trials, 1,886 patients; published in The Lancet) — in large-core stroke treated up to 24 hours after onset, 19.5% of thrombectomy patients reached functional independence at 90 days vs 7.5% with medical management.
LATE-MT — benefit out to 72 hours when CT perfusion confirmed salvageable tissue, though with higher rates of death and hemorrhage.
MILD-MT — patients with mild deficits (NIHSS <6) more often achieved excellent outcomes.
The pattern: eligibility is becoming physiology-based, not time-based. Every expansion of the treatable population raises the stakes for the imaging — and the transfer logic — that defines it.
The harder question isn’t can we treat more patients? It’s can stroke systems scale imaging interpretation and routing fast enough to reach them?
(LATE-MT and MILD-MT data are from conference presentations, publication pending; both were conducted in China — generalizability awaits replication.)
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