Outcomes of mechanical thrombectomy at a remote hospital lacking a neuroendovascular therapy specialist and mechanical thrombectomy practitioner in Japan

• The outcomes of MT in remote hospitals without neuroendovascular therapy specialists and MT practitioners remain unclear compared with those observed in randomized controlled trials. • This study demonstrated that the good functional outcome (mRS 0–2 at three months) and safety of MT performed by general neurosurgeons were not significantly different from those performed by specialists within the same institution. • MT performed by general neurosurgeons who have some experience (≥15 procedures and ≥5 years of experience), but without certification in neuroendovascular therapy should only be considered under carefully selected circumstances, including remote hospitals with limited access to thrombectomy-capable stroke centers, and should not be interpreted as a general recommendation. Randomized controlled trials assessing mechanical thrombectomy (MT) efficacy for acute large-vessel occlusion have primarily been conducted at high-volume stroke centers with extensive experience. In this study, we evaluated MT outcomes performed at a remote hospital lacking a neuroendovascular therapy specialist and MT practitioner in Japan. This single-center retrospective cohort study included 68 patients who underwent MT between April 2018 and March 2025. Patients were categorized into specialist-treated and general neurosurgeon-treated groups for comparison of clinical characteristics and outcomes. General neurosurgeons were defined as those without specialist or practitioner certification who had performed at least 15 MT procedures and five years of experience. Inverse probability weighting was applied to adjust for selection bias. Rates of successful recanalization (TICI 2b or 3), favorable functional outcome (mRS 0–2 at three months) and symptomatic intracranial hemorrhage (SICH) did not differ significantly between the two groups. The general neurosurgeon group had a significantly longer puncture-to-first-pass time and lower successful recanalization rate in large vessel occlusion due to intracranial atherosclerotic disease. However, the general neurosurgeon group required significantly fewer passes and achieved a higher rate of first-pass complete recanalization. In the general neurosurgeon group, successful recanalization was observed in 81%, favorable functional outcome in 63%, and SICH in 0%. MT performed by general neurosurgeons as defined in this study should only be considered under carefully selected circumstances including remote hospitals with limited access to thrombectomy-capable stroke centers and should not be interpreted as a general recommendation.