Meta-Analysis Evaluates Thrombectomy for Large-Core Stroke Up to 24 Hours After Onset

Ischemic stroke affecting large portions of the brain has historically been considered too severe for intervention, with many patients excluded from endovascular thrombectomy due to concerns that clot removal might not help — or could cause harm through hemorrhagic transformation. The ATLAS collaboration's systematic review and individual patient data meta-analysis, published in The Lancet on May 7, 2026, addresses this question by pooling data from randomized trials of thrombectomy in large-core stroke.

The analysis uses individual patient data with central imaging adjudication, meaning brain scans from contributing trials were independently re-evaluated by a central laboratory to ensure consistent classification of infarct size across studies. The population of interest is patients with large-core ischemic stroke presenting within 24 hours of symptom onset.

IMPORTANT NOTE: The source material available for this summary consists only of the article title, journal metadata, and author/collaborator list. The abstract text containing specific effect estimates, sample sizes, subgroup analyses, and conclusions was not provided. Therefore, quantitative results — including the number of trials pooled, total patient enrollment, functional outcome differences, mortality rates, and safety endpoints — cannot be reliably reported here. Readers should consult the full publication (doi: 10.1016/S0140-6736(26)00876-7) for the actual findings.

The ATLAS investigator group is large and international, with collaborators across North America, Europe, Asia, and Australia, suggesting the analysis draws on globally representative trial data. Central imaging adjudication is a methodological strength that reduces between-trial heterogeneity in how 'large-core' stroke is defined.