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Original research
Endovascular stroke therapy outside core working hours in a nationwide stroke system
  1. Simon Fandler-Höfler1,
  2. Dominika Mikšová2,
  3. Hannes Deutschmann3,
  4. Markus Kneihsl1,
  5. Sebastian Mutzenbach4,
  6. Monika Killer-Oberpfalzer4,5,
  7. Elke R Gizewski6,
  8. Michael Knoflach7,
  9. Stefan Kiechl7,
  10. Michael Sonnberger8,
  11. Milan R Vosko9,
  12. Jörg Weber10,
  13. Klaus A Hausegger11,
  14. Wolfgang Serles12,
  15. Philipp Werner13,
  16. Dimitre Staykov14,
  17. Marek Sykora15,
  18. Wilfried Lang15,
  19. Julia Ferrari15,
  20. Christian Enzinger1,
  21. Thomas Gattringer1,3
  22. on behalf of the Austrian EVT Study Group
    1. 1Department of Neurology, Medical University of Graz, Graz, Austria
    2. 2Austrian National Public Health Institute, Vienna, Austria
    3. 3Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
    4. 4Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University Salzburg, Salzburg, Austria
    5. 5Institute of Neurointervention, Christian Doppler Medical Center, Paracelsus Medical University Salzburg, Salzburg, Austria
    6. 6Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
    7. 7Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
    8. 8Institute of Neuroradiology, Kepler University Hospital Linz, Linz, Austria
    9. 9Department of Neurology, Kepler University Hospital Linz, Linz, Austria
    10. 10Department of Neurology, Klinikum Klagenfurt, Klagenfurt, Austria
    11. 11Institute of Diagnostic and Interventional Radiology, Klinikum Klagenfurt, Klagenfurt, Austria
    12. 12Department of Neurology, Medical University of Vienna, Vienna, Austria
    13. 13Department of Neurology, State Hospital of Feldkirch/Rankweil, Rankweil, Austria
    14. 14Department of Neurology, St. John’s Hospital, Eisenstadt, Austria
    15. 15Department of Neurology, St. John’s Hospital, Vienna, Austria
    1. Correspondence to Professor Thomas Gattringer, Department of Neurology, Medical University of Graz, Graz, Austria; thomas.gattringer{at}medunigraz.at

    Abstract

    Background Endovascular therapy (EVT) has been established as a major component in the acute treatment of large vessel occlusion stroke. However, it is unclear whether outcome and other treatment-related factors differ if patients are treated within or outside core working hours.

    Methods We analyzed data from the prospective nationwide Austrian Stroke Unit Registry capturing all consecutive stroke patients treated with EVT between 2016 and 2020. Patients were trichotomized according to the time of groin puncture into treatment within regular working hours (08:00–13:59), afternoon/evening (14:00–21:59) and night-time (22:00–07:59). Additionally, we analyzed 12 EVT treatment windows with equal patient numbers. Main outcome variables included favorable outcome (modified Rankin Scale scores of 0–2) 3 months post-stroke as well as procedural time metrics, recanalization status and complications.

    Results We analyzed 2916 patients (median age 74 years, 50.7% female) who underwent EVT. Patients treated within core working hours more frequently had a favorable outcome (42.6% vs 36.1% treated in the afternoon/evening vs 35.8% treated at night-time; p=0.007). Similar results were found when analyzing 12 treatment windows. All these differences remained significant in multivariable analysis adjusting for outcome-relevant co-factors. Onset-to-recanalization time was considerably longer outside core working hours, which was mainly explained by longer door-to-groin time (p<0.001). There was no difference in the number of passes, recanalization status, groin-to-recanalization time and EVT-related complications.

    Conclusions The findings of delayed intrahospital EVT workflows and worse functional outcomes outside core working hours in this nationwide registry are relevant for optimization of stroke care, and might be applicable to other countries with similar settings.

    • Stroke
    • Thrombectomy

    Data availability statement

    Data are available upon reasonable request. The datasets generated during this study are available from the corresponding author upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request. The datasets generated during this study are available from the corresponding author upon reasonable request.

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    Footnotes

    • Collaborators Austrian EVT Study Group: Wolfgang Serles, Stefan Greisenegger, Martha Marko, Florian Wolf, Christian Kinstner (Medical University of Vienna); Elisabeth Fertl, Peter Sommer, Sandrina Steiner, Rüdiger Schernthaner, Dominic Schauer (Klinik Landstraße, Vienna); Julia Ferrari, Marek Sykora, Stefan Krebs, Siegfried Thurnher, Christian Neumann (Hospital St John of God Vienna); Walter Struhal, Cornelia Brunner, Nilguen Yilmaz-Kaymaz, Christian Našel, Christian Filip (Universitätsklinikum Tulln); Christoph Waiß, Alexander Tinchon, Anna Fischer, Matthias Schilling, Michael Schwarz (Universitätsklinikum St Pölten); Mirja Wallner-Blazek, Thomas Wolf, Peter Schnider, Joachim Kettenbach, Wolfgang Krizmanich (Landesklinikum Wiener Neustadt); Milan R Vosko, Judith Wagner, Tim J von Oertzen, Franz A Fellner, Michael Sonnberger (Kepler University Hospital Linz); Johannes Sebastian Mutzenbach, Nele Bubel, Thomas Zellner, Monika Killer-Oberpfalzer, Erasmia Broussalis (Christian-Doppler-Clinic, Salzburg); Michael Knoflach, Christian Böhme, Lukas Mayer, Elke R Gizewski, Astrid E Grams (Medical University of Innsbruck); Elmar Höfner, Stephan Seiler, Jörg R Weber, Klaus Hausegger, Luca De Paoli (Klinikum Klagenfurt); Christian Enzinger, Thomas Gattringer, Birgit Poltrum, Hannes Deutschmann, Michael Augustin (Medical University of Graz); Dimitre Staykov, Almin Halilovic, Michael Frattner, Martin Wehrschütz, Patrick Kinsberger (St John’s of God Hospital, Eisenstadt); Philipp Werner, Andrea Mayr, Benjamin Matosevic, Manfred Cejna, Thomas Haglmüller (State Hospital of Feldkirch/Rankweil).

    • Contributors SF-H and TG conceived the study design, acquired data, interpreted the data and drafted the manuscript. DM performed the statistical analysis and revised the manuscript for important intellectual content. All other authors acquired data and revised the manuscript for important intellectual content. SF-H acts as the guarantor of this article.

    • Funding Research funding was provided by the Austrian Neurological Society and the Austrian Stroke Society.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.