In routine clinical practice, shorter onset-to-puncture times are associated with more favorable functional outcomes after endovascular thrombectomy, whereas treatment beyond 6 hours is associated with higher mortality.
Key Findings
Results
Longer onset-to-puncture time was independently associated with worse functional outcome on the modified Rankin Scale at 90 days.
Study included 288 consecutive patients with large vessel occlusion treated with endovascular thrombectomy at a large comprehensive stroke centre between 2024 and 2025.
Primary outcome was the modified Rankin Scale at 90 days, analysed using ordinal logistic regression.
Models were adjusted for demographic factors, prestroke functional status, baseline stroke severity, infarct burden, and occlusion characteristics.
Onset-to-puncture intervals of 4.5 to 6 hours and greater than 6 hours were each associated with higher odds of poorer modified Rankin Scale outcomes compared with treatment achieved within less than 4.5 hours.
Results
Delays in onset-to-puncture time beyond 6 hours were associated with increased 90-day mortality.
The association with increased mortality was specific to the greater than 6-hour onset-to-puncture interval group.
The 4.5 to 6-hour interval group did not show the same mortality association as the beyond 6-hour group.
Mortality was analyzed as a secondary outcome alongside excellent, independent, and favourable recovery, successful reperfusion, and symptomatic intracranial haemorrhage.
Results
No significant associations were observed between treatment timing and successful reperfusion or symptomatic intracranial haemorrhage.
Successful reperfusion rates did not significantly differ across onset-to-puncture time intervals.
Symptomatic intracranial haemorrhage rates did not significantly differ across onset-to-puncture time intervals.
These safety endpoints were pre-specified secondary outcomes in the analysis.
Background
The study examined associations of both prehospital and in-hospital treatment times with functional outcomes in a real-world stroke care setting.
The authors noted that randomised clinical trial estimates 'may not fully reflect real world practice because trial populations are highly selected and workflow conditions differ from routine care.'
The study was conducted at a large comprehensive stroke centre using consecutive patients, representing routine clinical practice rather than a selected trial population.
The study period spanned 2024 to 2025 with a sample of 288 patients.
What This Means
This research examined whether the time between stroke onset and the start of a clot-removal procedure (endovascular thrombectomy) affected patient recovery in everyday hospital care, not just in carefully controlled clinical trials. Researchers followed 288 consecutive stroke patients treated at a large stroke center and assessed their level of disability 90 days after treatment. They found that patients who received treatment within 4.5 hours had the best outcomes, those treated between 4.5 and 6 hours had worse outcomes, and those treated after 6 hours had the worst outcomes — including a higher risk of death.
Importantly, the timing of treatment did not appear to affect whether the clot was successfully removed or whether patients experienced dangerous bleeding in the brain, suggesting that later treatment remains technically feasible but yields worse overall recovery. These findings align with what has been shown in clinical trials but now confirm the pattern in a real-world setting where patients are more varied and hospital workflows are less controlled than in research studies.
This research suggests that reducing avoidable delays in getting stroke patients to treatment — whether in the time before reaching the hospital or within the hospital itself — could meaningfully improve patient outcomes. At the same time, the authors caution that time alone should not be the only factor guiding treatment decisions, as individual patient characteristics and the nature of each stroke also matter.
Qiao Y, Yan Y, Guo T, Wang L, Wang L. (2026). Treatment time metrics and functional outcomes after endovascular thrombectomy in routine clinical practice.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1808012