Abstract 106: First National Analysis of Mechanical Thrombectomy Timelines and Outcomes Across Kazakhstan's Stroke Centers

Introduction/Purpose Stroke is a leading cause of mortality and disability in Kazakhstan, with acute ischemic stroke (AIS) outcomes highly dependent on timely mechanical thrombectomy (MTE). Despite the establishment of certified stroke centers, regional disparities in access, workflow efficiency, and outcomes remain underexplored. This study aimed to evaluate interregional differences in MTE timelines, procedural performance, and discharge outcomes to identify systemic gaps and guide national stroke care improvement. Materials/Methods We retrospectively reviewed 338 AIS patients treated with MTE between 2022 and 2024 in five regions (Atyrau, Turkestan, Karagandy, Kostanay, Abay). Inclusion criteria included age ≥18 years, confirmed large vessel occlusion, and discharge mRS data. Collected variables included demographics, comorbidities, stroke severity (NIHSS), imaging findings, procedural details, and workflow intervals: symptom onset‐to‐door, door‐to‐CT, CT‐to‐groin, and total procedure time. Primary outcome was favorable discharge mRS (0‐2). Secondary analyses evaluated predictors of outcome, reperfusion success (TICI score), hospital stay length, and regional variations in treatment timelines. Statistical comparisons used Wilcoxon, Chi‐square, Fisher's exact, and ANOVA tests with post‐hoc analyses. Results Median age was 66 years; 63% were male. Hypertension was present in 99% of patients; 15% had diabetes. Favorable outcomes (mRS 0‐2) occurred in 30.5% of Atyrau patients and 26.3% of Abay patients, while Turkestan had the highest poor outcome rate (mRS 5‐6: 41.9%). TICI 3 reperfusion was associated with lower NIHSS at discharge and shorter hospital stays (median 9 days) compared to incomplete reperfusion. Only 50.4% of patients received MTE within the 6‐hour window, with significant regional variation: Kostanay (68.4%) and Turkestan (65.1%) outperformed Atyrau and Karagandy, where over 60% were treated late. Kostanay had the shortest median onset‐to‐door time (69 minutes) and Karagandy the longest (239.5 minutes). Admission‐to‐CT delays were greatest in Karagandy (39.5 minutes) and shortest in Kostanay (8 minutes). Procedure times ranged from 50 minutes (Abay) to 110 minutes (Atyrau). Female sex, older age, higher admission NIHSS, and longer procedure duration predicted poor outcomes. Reperfusion quality (TICI 3 vs. lower grades) was a strong determinant of neurological recovery regardless of treatment timing. Conclusion This multicenter study highlights significant disparities in stroke care delivery across Kazakhstan, with only half of patients receiving MTE within recommended timeframes. Regional differences in prehospital and in‐hospital workflow performance strongly influenced outcomes, while complete reperfusion was the most consistent predictor of recovery. These findings underscore the urgent need for standardized national protocols, improved emergency medical services, and expanded access to thrombectomy‐capable centers. Implementing data‐driven, region‐specific stroke systems of care can improve equity, reduce disability, and lessen the socioeconomic burden of stroke in Kazakhstan.