RT Journal Article SR Electronic T1 Endovascular stroke therapy outside core working hours in a nationwide stroke system JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP jnis-2022-020044 DO 10.1136/jnis-2022-020044 A1 Simon Fandler-Höfler A1 Dominika Mikšová A1 Hannes Deutschmann A1 Markus Kneihsl A1 Sebastian Mutzenbach A1 Monika Killer-Oberpfalzer A1 Elke R Gizewski A1 Michael Knoflach A1 Stefan Kiechl A1 Michael Sonnberger A1 Milan R Vosko A1 Jörg Weber A1 Klaus A Hausegger A1 Wolfgang Serles A1 Philipp Werner A1 Dimitre Staykov A1 Marek Sykora A1 Wilfried Lang A1 Julia Ferrari A1 Christian Enzinger A1 Thomas Gattringer A1 , YR 2023 UL http://jnis.bmj.com/content/early/2023/02/22/jnis-2022-020044.abstract AB 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.Data are available upon reasonable request. The datasets generated during this study are available from the corresponding author upon reasonable request.