Introduction Large vessel occlusion (LVO) strokes are time‐sensitive emergencies requiring rapid thrombectomy for optimal outcomes. Prior studies suggest that presentation during off‐duty hours may delay workflow metrics, potentially impacting patient recovery. This study seeks to evaluate if the timing of endovascular stroke alerts (business hours vs off‐duty hours) impacts treatment metrics and clinical outcomes in patients who undergo a mechanical thrombectomy procedure at a large academic medical center. Methods We conducted a retrospective cohort study of adult patients (≥18 years) with LVO who underwent mechanical thrombectomy following an endovascular alert between September 2022 and July 2025. In the context of this study, an “endovascular alert” refers to the activation of the neuro‐interventional team once the decision for thrombectomy is made, distinct from the initial emergency department stroke alert. Alerts were categorized as business hours (7:00‐16:59 Monday to Friday) or off‐duty hours (17:00‐7:59 Monday to Friday; all weekends). Exclusion criteria included inpatient or mobile stroke unit alerts. Demographics, comorbidities, time metrics (alert to operating room OR, puncture, and revascularization), and outcomes (Thrombolysis in Cerebral Infarction TICI score, discharge modified Rankin Scale mRS, National Institutes of Health Stroke Scale NIHSS) were extracted from a prospectively maintained quality database. Between‐group comparisons were performed using t‐tests and chi‐square tests. Results A total of 232 patients were analyzed (business hours n=104; off‐duty n=128). Baseline demographics and vascular risk factors were balanced between groups. Patients presenting during business hours demonstrated significantly shorter workflow intervals. Mean endovascular alert‐to‐OR time was 10.1 minutes (SD 7.8) for business hours vs 13.0 minutes (SD 11.0) for off‐duty (p=0.021). Similarly, alert‐to‐puncture time was 21.0 minutes (SD 12.3) vs 26.0 minutes (SD 10.2), respectively (p=0.001). There was no significant difference in alert‐to‐revascularization time (44.9 vs 48.0 minutes, p=0.193). Procedural success was similar, with TICI 2b/3 achieved in 93.3% of business hours vs 92.2% of off‐duty alerts (p=1.0). Functional outcomes did not differ, good outcome (mRS 0‐2 at discharge) occurred in 33.7% of business hours vs 31.3% of off‐duty cases (p=0.602). There were no differences in discharge NIHSS and length of stay between groups. Conclusion Although endovascular stroke alerts activated during business hours were associated with shorter time to OR arrival and arterial puncture, these workflow advantages did not translate into differences in revascularization times, procedural success, or discharge functional outcomes. These findings suggest that despite modest workflow delays after routine business hours, emergency response systems for mechanical thrombectomy yield effective clinical outcomes. Future studies are needed to identify further opportunities to streamline off‐hour workflows without compromising patient outcomes.
Saini et al. (2025) studied this question.