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

Abstract

Introduction—There 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.
Methods—Our 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.
Results—98 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-groinpuncture 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).
Conclusions—There 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.
AF atrial fibrillation
AIS acute ischemic stroke
CTA computed tomography angiography
DM diabetes mellitus
ENT embolization to new territory
EVT endovascular therapy
HLP hyperlipoproteinemia
HTN hypertension