Current Status and Treatment Outcomes of Mechanical Thrombectomy for Acute Large Vessel Occlusion during On- and Off-Hours in Our Institution

Q: What are the key findings of this study?

Off-hours mechanical thrombectomy had similar 90-day mRS 0-3 rates to on-hours treatment (45.5% vs 50.0%; adjusted OR 0.917, p=0.845) despite longer door-to-puncture times.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute anterior circulation large vessel occlusion stroke (n=101). Intervention: Off-hours presentation for mechanical thrombectomy vs. On-hours presentation (9:00-17:00 Mondays-Saturdays, excluding holidays). Primary outcome: 90-day modified Rankin Scale (mRS) 0-3 (OR 0.917, 95% CI 0.386-2.179, p=0.845).

Q: What does this research mean for the field?

Off-hours mechanical thrombectomy achieves similar 90-day functional outcomes and recanalization rates compared to on-hours treatment despite significant in-hospital treatment delays. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yu Kanazawa; Tomoyoshi Kuribara; 勇介 新田; Shinya Kohyama; Hiroshi Miyazaki; Hiroshi Nawashiro; H Kita

doi:10.5797/jnet.oa.2026-0065

January 1, 2026Journal of Neuroendovascular TherapyOpen Access

Current Status and Treatment Outcomes of Mechanical Thrombectomy for Acute Large Vessel Occlusion during On- and Off-Hours in Our Institution

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Key result

Off-hours mechanical thrombectomy yields similar 90-day functional outcomes to on-hours treatment despite treatment delays.

OR 0.917
95% CI 0.386-2.179
P=0.845
n=101

Why the study?

Mechanical thrombectomy is the standard of care for acute large vessel occlusion, but off-hours treatment may be delayed due to limited staffing, prompting a comparison of on-hours and off-hours outcomes.

Does performing mechanical thrombectomy during off-hours compared to on-hours affect 90-day functional outcomes (mRS 0–3) and procedural time metrics in patients with acute anterior circulation large vessel occlusion?

Key Points

To compare clinical outcomes and procedural time metrics of mechanical thrombectomy between on-hours and off-hours presentation, and to identify factors associated with 90-day modified Rankin Scale scores of 0–3.
Retrospective single-center study analyzing 101 patients with anterior circulation acute large vessel occlusion treated between January 2020 and December 2025.
Patients were categorized into on-hours (n = 46; 9:00–17:00 on regular working days) and off-hours (n = 55; all other times) groups based on hospital arrival time.
Primary outcomes evaluated included 90-day modified Rankin Scale (mRS) 0–3, successful recanalization (TICI 2b–3), symptomatic intracranial hemorrhage, and time metrics.
A 90-day mRS score of 0–3 was achieved in 50.0% (23/46) of on-hours patients and 45.5% (25/55) of off-hours patients (p = 0.692).
Successful recanalization (TICI 2b–3) occurred in 82.6% (38/46) on-hours versus 80.0% (44/55) off-hours (p = 0.802), with symptomatic intracranial hemorrhage in 4.3% versus 3.6% (p = 1.000).
In-hospital delays were longer off-hours, including median door-to-puncture time (103 vs. 71 min, p < 0.001) and door-to-recanalization time (151 vs. 124 min, p = 0.003), but multivariable regression showed younger age (OR 0.922, p = 0.002) independently predicted mRS 0–3, whereas off-hours status did not.

Study Design

Type

Cohort (n=101)

Multicenter

No

Structured PICO

Does performing mechanical thrombectomy during off-hours compared to on-hours affect 90-day functional outcomes (mRS 0–3) and procedural time metrics in patients with acute anterior circulation large vessel occlusion?

P

Population

101 adult patients (median age 80 years, 42.6% female) with acute anterior circulation large vessel occlusion and pre-stroke mRS 0-2 undergoing mechanical thrombectomy at a single Japanese center, followed for 90 days.

E

Exposure

Mechanical thrombectomy (MT) using a combined (stent retriever and aspiration) technique performed during off-hours (all times outside 9:00–17:00 on Mondays through Saturdays, including national holidays and December 31 to January 3; n=55), with intravenous thrombolysis with tissue-type plasminogen activator (IV tPA) administered in 38.2% of patients.

C

Comparator

Mechanical thrombectomy (MT) using a combined (stent retriever and aspiration) technique performed during regular on-hours (9:00–17:00 on Mondays through Saturdays, excluding national holidays and December 31 to January 3; n=46), with IV tPA administered in 39.1% of patients.

O

Outcome

90-day modified Rankin Scale (mRS) score of 0–3hard clinical

Main Result

Odds Ratio: 0.917 (95% CI 0.386–2.179)

Absolute Event Rate: 45.5% vs 50%

p-value: p=0.845

Although off-hours presentation for mechanical thrombectomy resulted in significant in-hospital delays from imaging to arterial puncture due to on-call staffing workflows, 90-day functional outcomes (mRS 0–3) and recanalization rates were comparable to on-hours treatment.

Limitations

Single-center retrospective design with a limited sample size (n=101), constraining statistical power
Symptom onset time was unknown in 38 patients (37.6%), requiring use of last known well time
In 13 patients without recanalization, the time of the final angiographic run was used as a surrogate for recanalization time
Multivariable logistic regression was limited to 4 covariates due to events-per-variable constraints, leaving potential residual confounding (e.g., sex imbalance, occlusion side)
Retrospective records lacked data on whether specialists or staff were called in from outside the hospital and their call-to-arrival times
Single-center retrospective design
Limited number of outcome events with potential for model instability
Detailed records to retrospectively analyze specific causes of in-hospital delays (such as exact arrival times of on-call staff) were not available

Implication

May support off-hours MT feasibility despite delays; leaves open whether workflow optimizations improve outcomes in prospective studies.

Abstract

Objective: Mechanical thrombectomy (MT) is the standard of care for acute large vessel occlusion (LVO); however, off-hours treatment may be delayed because of limited staffing. We compared MT outcomes between on-hours and off-hours at a single center and investigated factors associated with 90-day modified Rankin Scale (mRS) 0–3.

Discussion

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Cite This Study

Kanazawa et al. (2026) conducted a cohort in Acute anterior circulation large vessel occlusion stroke (n=101). Off-hours presentation for mechanical thrombectomy vs. On-hours presentation (9:00-17:00 Mondays-Saturdays, excluding holidays) was evaluated on 90-day modified Rankin Scale (mRS) 0-3 (OR 0.917, 95% CI 0.386-2.179, p=0.845). Off-hours mechanical thrombectomy had similar 90-day mRS 0-3 rates to on-hours treatment (45.5% vs 50.0%; adjusted OR 0.917, p=0.845) despite longer door-to-puncture times.

synapsesocial.com/papers/6adc966ca704d151585a5e09 https://doi.org/10.5797/jnet.oa.2026-0065

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Current Status and Treatment Outcomes of Mechanical Thrombectomy for Acute Large Vessel Occlusion during On- and Off-Hours in Our Institution

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Current Status and Treatment Outcomes of Mechanical Thrombectomy for Acute Large Vessel Occlusion during On- and Off-Hours in Our Institution

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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