ABSTRACT NUMBER: ESOC2026LB64 RECENTLY COMPLETED RE-AUDIT OF OUT-OF-HOURS MECHANICAL THROMBECTOMY ACCESS FOR ANTERIOR CIRCULATION STROKE IN A UK TERTIARY CENTRE

Abstract Background and aims Access to mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO) stroke remains variable outside standard working hours in many stroke centres. Although late-window thrombectomy is supported by advanced imaging–based selection, structured reassessment pathways for out-of-hours (OOH) presentations are inconsistently implemented. The re-audit data presented here were generated after the standard abstract submission deadline. The aim is to report recently completed re-audit findings following implementation of a structured late-window reassessment protocol for OOH anterior circulation LVO stroke. Methods An initial audit of OOH anterior circulation LVO stroke presentations was conducted at a UK tertiary stroke centre. A structured protocol was introduced, including mandatory CT angiography, defined CT perfusion triggers, registrar-level neuroradiology discussion, and documented reassessment prior to the next available MT session. A prospective re-audit of consecutive OOH LVO patients was completed between July and September 2024. Imaging utilisation, multidisciplinary discussion, and access to MT were recorded descriptively. Results Twenty-eight patients were included in the re-audit. CT angiography was performed in 100% of cases and CT perfusion in 71%, compared with lower utilisation at baseline. Documented neuroradiology discussion occurred in all eligible cases. The proportion of OOH patients receiving MT increased from 22% to 39%. Among MT recipients, approximately 65% achieved modified Rankin Scale 0–2 at discharge. No adverse safety or service impacts were identified. Conclusions Recently completed re-audit data demonstrate that a structured late-window reassessment protocol can improve imaging utilisation, multidisciplinary decision-making, and access to MT for OOH anterior circulation stroke without service expansion. Conflict of interest