Abstract 458: Mastering Acute Stroke Care in Armenia: The Six‐Year Dynamics of Thrombectomy Team Optimization (2019‐2024)

Background Mechanical thrombectomy (MT) has revolutionized acute ischemic stroke care, but single‐team efficiency trends remain underexplored. In 2019, Armenia's National Stroke Program began funding acute stroke treatments (intravenous thrombolysis and MT), enabling them for country's mostly uninsured population. We evaluated workflow improvements in Armenia's busiest MT‐performing stroke center over a period of six years (2019‐2024). Methods We analyzed data for 1283 consecutive MTs (2019‐2024), performed by a single team (a total of three neurointerventionalists, two neuroanesthesiologists, two assistants) at the country's busiest stroke center. Metrics included case volume, door‐to‐puncture (DTP) time, puncture‐to‐reperfusion (PTR) time, overall successful reperfusion (TICI 2B+), and first pass effect (FPE) success (TICI2B+). Trends were assessed using Kruskal‐Wallis and Chi‐square tests. Results Median DTP time decreased from 106.1 min (IQR 49.8) in 2019 to 87.3 min (IQR 32.0) in 2024 (Kruskal‐Wallis, p<0.001). Puncture‐to‐reperfusion time decreased from 35.0 min (IQR 30.0) in 2019 to 28.0 min (IQR 30.5) in 2024 (p<0.001). Final TICI 2B+ reperfusion rate increased from 85.6% (107/125) in 2019 to 94.5% (207/219) in 2024 (Chi‐square, p<0.001). FPE success rate increased from 40.8% in 2019 to 52.5% in 2024. Overall MT volume increased from 125 in 2019 to 247 in 2023, with 219 in 2024. Conclusion A unified MT team at a high‐volume stroke center in Armenia has achieved significant workflow improvements over several years, with faster DTP and PTR times and higher and faster reperfusion rates, highlighting the importance of team dynamics in stroke care excellence.