The impact of off-hour mechanical thrombectomy therapy on outcomes for acute ischemic stroke: A systematic review and...

The impact of off-hours and on-hours mechanical thrombectomy (MT) treatment for acute ischemic stroke (AIS) is not well understood. We conducted a systematic review and met-analysis comparing outcomes between patients undergoing off-hours MT versus on-hours MT.

This study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. A systematic literature review of the English language literature was conducted using Web of Science, Embase, Scopus, and PubMed databases. We included all original studies comparing off-hour and on-hour outcomes or time metrics in AIS undergoing MT. R software version 4.3.1 and the 'meta' statistical package were used to analyze all the data presented in this study.

We included 26 studies with 82,850 patients. Patients undergoing MT during off-hours achieved lower rates of 90-day functional independence (OR 0.92, 95% CI 0.86-0.99; p = 0.04) and successful recanalization (OR 0.89, 95% CI 0.81-0.98; p = 0.014). Patients undergoing off-hours MT experienced similar rates of 90-day mortality (OR 1.07, 95% CI 0.96-1.19; p = 0.21) and sICH (OR 1.04, 95% CI 0.85-1.28; p = 0.674). Patients in the off-hour group experienced longer onset to door time (MD = 12.23 min; 95% CI 4.53-19.93; p = 0.002), imaging to puncture time (MD = 10.59 min; 95% CI 4.00-17.19; p = 0.002), and door to recanalization time (MD = 13.31 min; 95% CI 4.60-22.03; p = 0.003).

Patients undergoing MT for AIS during off-hours experienced lower rates of functional independence. This may be attributed to treatment delays during off-hours. Future studies should work to optimize hospital workflows and identify factors which may contribute to treatment delays.