Analyzing Prehospital Delays in Endovascular Treatment for Acute Stroke

Objective: Delayed emergency responses in patients with large vessel occlusion stroke (LVOS) are associated with reduced access to timely reperfusion therapy and worse clinical outcomes. The present study was aimed at identifying modifiable factors contributing to delays before hospital arrival in LVOS patients undergoing endovascular treatment (EVT).

Methods: In this retrospective analysis of prospectively collected data, consecutive acute LVOS patients undergoing EVT at two comprehensive stroke centers between December 2020 and December 2021 were enrolled. Neurologists administered a standardized questionnaire to patients or their caregivers within 24 h after the procedure. Emergency response delay was defined as onset to groin (OTG) time, measured from symptom onset or last known normal to groin puncture, exceeding 6 h. Baseline characteristics, process times, and clinical data were collected for all enrolled patients, and factors influencing the emergency process and outcomes were analyzed.

Results: Of the 366 patients initially considered, 14 with in-hospital stroke were excluded, leaving 352 patients for analysis. The median age was 70 years (63, 76), and 135 patients (38.4%) experienced treatment delays. The median National Institutes of Health Stroke Scale (NIHSS) score was 14 (11, 18), and the median Alberta Stroke Program Early CT Score (ASPECTS) was 9 (7.85, 10). Multivariate analysis identified the main modifiable factors associated with reduced emergency response delay as early calling of emergency services (odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.22–0.76), initial consultation with a neurologist (OR = 0.35, 95% CI: 0.20–0.62), and stroke awareness (OR = 0.51, 95% CI: 0.29–0.89). Among elderly patients and those whose stroke onset occurred during sleep, early contact with emergency services (120) significantly reduced prehospital delays (OR = 0.48, 95% CI: 0.21–0.94 and OR = 0.30, 95% CI: 0.10–0.86).

Conclusion: Emergency physician involvement, stroke awareness, and early calling of emergency services (120) are modifiable factors that can reduce delays in the emergency response process. For patients eligible for EVT, minimizing prehospital delays may require prioritizing both community education on stroke recognition and system-level improvements to ensure rapid emergency activation and timely neurological assessment.