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Current Status and Treatment Outcomes of Mechanical Thrombectomy for Acute Large Vessel Occlusion during On- and Off-Hours in Our Institution

Year: 2026

Type: article

Abstract: Objective: Mechanical thrombectomy (MT) is the standard of care for acute large vessel occlusion (LVO); however, off-hours treatment may be delayed because of limited staffing. We compared MT outcomes between on-hours and off-hours at a single center and investigated factors associated with 90-day modified Rankin Scale (mRS) 0-3. Methods: We retrospectively analyzed 101 consecutive patients with anterior circulation LVO and a pre-stroke mRS 0-2 who underwent MT at Tokorozawa Central Hospital between January 2020 and December 2025. Patients were classified into on-hours (9:00-17:00 on Mondays through Saturdays, excluding national holidays and the period from December 31 to January 3) and off-hours groups based on hospital arrival time. The primary endpoint was 90-day mRS 0-3. Secondary endpoints included Thrombolysis in Cerebral Infarction (TICI) grade 2b-3, symptomatic intracranial hemorrhage (sICH), and any intracranial hemorrhage. Time metrics, including onset-to-door time (ODT), door-to-image time, door-to-needle time, image-to-puncture time (IPT), door-to-puncture time (DPT), puncture-to-recanalization time (PRT), door-to-recanalization time (DRT), and onset-to-recanalization time (ORT), were compared between the 2 groups, and factors associated with 90-day mRS 0-3 were evaluated using univariable and multivariable logistic regression analyses. Results: The on-hours group comprised 46 patients and the off-hours group 55 patients. Compared with the on-hours group, the off-hours group had significantly longer IPT (median 83 vs. 51 min, p <0.001), DPT (median 103 vs. 71 min, p <0.001), and DRT (median 151 vs. 124 min, p = 0.003). ODT and ORT did not differ significantly between the groups (median 105 vs. 89 min, p = 0.825, and median 285 vs. 234 min, p = 0.154, respectively). PRT did not differ significantly between groups (median 53 vs. 48 min, p = 0.626). The proportion of patients achieving 90-day mRS 0-3 did not differ significantly between groups (45.5% vs. 50.0%, p = 0.692). No significant differences were observed in TICI 2b-3 (80.0% vs. 82.6%, p = 0.802) or sICH (3.6% vs. 4.3%, p = 1.000). In the multivariable logistic regression, younger age (odds ratio [OR] 0.922, p = 0.002) was an independent predictor of 90-day mRS 0-3, whereas off-hours status was not (OR 0.917, p = 0.845). Conclusion: Despite prolonged time from hospital arrival to treatment initiation in the off-hours group, the proportion of patients achieving 90-day mRS 0-3 did not differ significantly between groups. In multivariable logistic regression, younger age was an independent predictor of 90-day mRS 0-3. Further efforts are needed to identify the causes of off-hours delays and to improve our clinical care system.

Source: Journal of Neuroendovascular Therapy

DOI: 10.5797/jnet.oa.2026-0065