Introduction: Endovascular treatment for acute ischemic stroke patients with large vessel occlusion has been established as a promising clinical intervention within a late time window of 6-24-hours after symptom onset. Patients with slow progression, however, may still benefit from endovascular treatment beyond the 24-hour time window (very late window). Aim: To report insight into the potential clinical benefits of endovascular treatment for acute ischemic stroke beyond 24 hours from symptom onset. Methods: A retrospective analysis was performed on consecutive patients undergoing endovascular treatment for acute anterior circulation large vessel occlusion ischemic stroke beyond 24 hours. Participants were recruited between July 2019 and November 2020. Patients were selected based on the DAWN/DEFUSE 3 criteria (Perfusion-RAPID, IschemaView), and patients receiving treatment beyond 24 hours were compared to a group of patients receiving endovascular treatment between 6-24 hours after symptom onset. The primary outcome was the proportion of patients with functional independence at 90 days (modified Rankin Scale score of 0-2). The secondary outcomes were shift mRS analysis and successful reperfusion was defined by TICI 2b-3 on the final procedure. Safety outcomes were symptomatic intracranial hemorrhage and death at the 90-day follow-up. Propensity score-matched analyses were employed to rectify the imbalanced baseline characteristics between the two groups. Results: 166 patients were recruited with a median age of 63.0 [56.0-69.0] and 28.9% of all patients were females. Patients in the beyond 24-hour group had a longer onset-to-groin time (median, 27.2 vs. 14.3 hours, p<0.001) than those in the 6 to 24-hour group. There were no statistically significant differences between the two groups in NIHSS (median, 12.0 vs. 15.0, p=0.37), perfusion imaging characteristics (core: median, 11.0 vs. 9.0 ml, p=0.86; mismatch volume: median, 106.0 vs. 96.0, p=0.44; mismatch ratio: 6.46 vs. 7.24, p=0.91), and perfusion-to-groin time (median, 72.5 vs. 76.0 min, p=0.77). No significant differences were noted among patients between the two groups in the primary endpoint functional independence analysis (50.0% vs. 46.6%, p=0.77) and in the safety endpoint analysis: mortality (15.0% vs. 11.0%, p=0.71) or symptomatic hemorrhage (0% vs. 3.42%, p>0.999). In propensity score–matched analyses, there were no significant differences among patients between the two groups in functional independence (50.0% vs. 54.8%, p=0.74), mortality (16.7% vs. 9.68%, p=0.50) or symptomatic hemorrhage (0% vs. 6.45%, p=0.53). Conclusions: Endovascular treatment can be performed safely and effectively in large vessel occlusion patients beyond 24 hours from symptom onset when selected by target mismatch profile. The clinical outcome of these patients was comparable to those treated in the 6-24 hour window. Larger studies are needed to confirm these findings.