A minimum of 24-hour bed rest after mechanical thrombectomy (MT) following AIS remains widely practiced, yet its benefit over earlier mobilization is unclear.

1173 patients were included (638 ≥12h, 535 ≥24h). Mean (s.d.) age was 70.2 (14.7) and 69.2 (14.6). Median (IQR) NIHSS was 14.0 (7-20) and 15.0 (8-21). Mean (s.d.) door-to-puncture times (minutes) were 106.4 (167.9) and 116.8 (157.5). TICI ≥2b was achieved in 97.4% and 95.7% of patients (Likelihood Ratio χ² p=0.20). Favorable discharge location was similar between groups in unadjusted χ²-test of proportions (64.1% vs 65.4%, Likelihood Ratio χ² p=0.64) and multivariable logistic regression analysis (Wald χ² p=0.99; adjusted OR=1.00; 95% CI=0.76:1.31). The frequency of good outcomes (mRS=0-2) by 90 days (37.3% vs. 39.8%, χ² p=0.65) was similar. Unplanned readmission rates at 30 days (8.9 vs. 6.9%, LR χ² p=0.43) and 90 days (19.9% vs. 15.1%, LR χ² p=0.18) were not different. In the ≥12h group, pneumonia rates were higher (unadjusted: 8.2% vs. 5.1%, LR χ² p=0.033; adjusted OR= 1.81 (95% CI= 1.09: 3.01), and median (IQR) length of stay was longer (6.0 days vs. 5.1 days, Wilcoxon p <0.001).

After adjustment, ≥12h bed rest following AIS treated with MT showed no significant difference in favorable discharge or readmission rates compared to ≥24h. Higher pneumonia rates and longer stays in the ≥12h group likely reflect unmeasured factors, indicating the need for randomized trials.