Treatment time metrics and functional outcomes after endovascular thrombectomy in routine clinical practice

Randomised clinical trials have shown that functional outcomes after acute ischaemic stroke decline with each hour of delay to endovascular treatment. However, these estimates may not fully reflect real world practice because trial populations are highly selected and workflow conditions differ from routine care. We therefore examined the associations of prehospital and in-hospital treatment times with functional outcomes and safety endpoints among patients undergoing endovascular thrombectomyat a large comprehensive stroke centre.

We conducted a study of consecutive patients with large vessel occlusion treated with endovascular therapy between 2024 and 2025. The primary outcome was the modified Rankin Scale at 90 days, analysed using ordinal logistic regression. Secondary outcomes included excellent, independent, and favourable recovery, mortality, successful reperfusion, and symptomatic intracranial haemorrhage. Models were adjusted for demographic factors, prestroke functional status, baseline stroke severity, infarct burden, and occlusion characteristics.

Among 288 patients, longer onset-to-puncture time was independently associated with worse functional outcome. Compared with treatment achieved within less than 4.5 h, onset-to-puncture intervals of 4.5 to 6 h and greater than 6 h were associated with higher odds of poorer modified Rankin Scale outcomes. Delays beyond 6 h were also associated with increased 90-day mortality. No significant associations were observed between treatment timing and successful reperfusion or symptomatic intracranial haemorrhage.

In routine clinical practice, shorter onset-to-puncture times are associated with more favorable functional outcomes after endovascular thrombectomy, whereas treatment beyond 6 h is associated with higher mortality. These findings highlight the importance of minimizing avoidable delays in acute stroke care while underscoring the need to interpret time-based metrics within the context of patient selection and stroke heterogeneity.