Endovascular stroke therapy at nighttime and on weekends-as fast and effective as during normal business hours?

introductionThere is only limited data on the influence of the admission time (normal business hours versus nighttime and weekends) on procedural timings, revascularization efficacy, and outcome after mechanical thrombectomy. We investigated whether the admission time has an impact on the above-mentioned factors.

methodsOur neurointerventional database was screened for all mechanical thrombectomies in anterior circulation acute ischemic stroke between 07/13 and 06/14. Outcome measures were procedural timings and clinical and demographic data; we compared patients who were admitted at normal business hours (Monday to Friday 8:00-18:00) to those admitted at night or at the weekend.

results98 patients were identified. Of them, 52 (53%) were admitted during normal business hours, the remainder at night or at weekend. There was no statistically significant difference between the groups regarding the time from symptom-onset to admission, baseline National Institutes of Health Stroke Scale (NIHSS) or IVT-rate. There was a significant difference between groups for door-to-reperfusion timing, favoring patients admitted during normal business hours (146 versus 165 min, p = 0.02). Door-to-groin-puncture and groin-puncture-to-reperfusion time did not differ significantly. The rate of successful revascularizations (mTICI ≥ 2b) and the rate of favorable clinical outcome at discharge (mRS ≤ 2) did not differ between groups (77% versus 78% and 37% versus 35%, respectively).

conclusionsThere was a statistically significant prolongation of door-to-reperfusion timings for patients admitted during nighttime and weekends; it went along neither with a lower rate of successful revascularizations nor with a lower rate of favorable outcome in our series. ABBREVIATIONS: AFatrial fibrillationAISacute ischemic strokeCTAcomputed tomography angiographyDMdiabetes mellitusENTembolization to new territoryEVTendovascular therapyHLPhyperlipoproteinemiaHTNhypertensionIQRinter-quartile rangeIVTintravenous thrombolysismRSmodified Rankin ScaleMTmechanical thrombectomyNIHSSNational Institutes of Health Stroke Scalen.s.not significantsICHsymptomatic intracranial hemorrhage.