Lancet ATLAS meta-analysis: thrombectomy benefits large-core strokes up to 24 hours

London, May 7. The ATLAS individual-patient-data meta-analysis published in The Lancet on May 7, 2026 has delivered a critical finding in acute ischaemic stroke care.

Six-trial pooled analysis

Researchers pooled data on 1,886 patients across six major trials — RESCUE-Japan LIMIT, ANGEL-ASPECT, SELECT2, TENSION, TESLA, and LASTE. This is the largest meta-analysis to date in stroke research.

Benefit within 24 hours

In patients with acute anterior circulation stroke, endovascular thrombectomy within 24 hours significantly improved functional outcomes and reduced mortality compared with medical management. It is a major extension beyond the previous 6-hour window.

What is thrombectomy

Thrombectomy is a minimally invasive procedure that removes a blood clot via a catheter — restoring blood supply to the brain without open surgery. It is available at about 200 hospitals in India.

Robustness of findings

The benefit was sustained across ASPECTS and ischaemic-core strata; evidence remained limited only for core volume >=150 mL beyond 6 hours. Lead author Professor Keith W. Muir said, "This supports expanding eligibility for large-core stroke thrombectomy in clinical guidelines."

Relevance for India

India sees an estimated 1.8 million strokes a year, of which roughly one-third are fatal and another third leave permanent disability. AIIMS Delhi and the Bangur Institute of Neurology in Kolkata have welcomed the findings.

Guidelines to change

The American Heart Association (AHA) and European Stroke Organisation (ESO) have announced updates to their guidelines by end-2026. This will make millions of additional patients eligible for treatment.