ABSTRACT NUMBER: ESOC2026A1997 DETERMINANTS OF TIME TO THROMBECTOMY: A REAL-WORLD PATHWAY ANALYSIS FROM THE GERMAN STROKE REGISTRY

Abstract Background and aims Delayed time to groin puncture is associated with worse functional outcome in acute ischemic stroke. Prehospital time intervals and organizational determinants remain insufficiently investigated using individual patient data. This study identifies drivers of delay from symptom onset to groin puncture. Methods 18,028 patients from the German Stroke Registry (2015-2023) were included. Time intervals covered prehospital (Onset/Recognition-to-Admission) and intrahospital (Door-to-Imaging and Imaging-to-Groin) phases. Multivariable linear regression and predefined path analysis (Figure 1) assessed associations of demographics, NIHSS, admission time, CT-perfusion and transfers, adjusted for infarct location, premorbid mRS and oral anticoagulation. Results Median age was 76.0 years and 51.8% were female. 57.4% (n = 10,355) were directly admitted to thrombectomy centres. In multivariable analysis, female sex was associated with a delayed prehospital recognition (P = 0.001; Figure 2B). Intrahospital metrics (Door-to-Imaging/-Groin) were independent of sex, and total processing time remained unaffected by premorbid disability (Figure 2D-F). Higher NIHSS accelerated intrahospital processes (-1.2% per point; P < 0.001; Figure 2D-F). Night-time admission showed faster imaging (Door-to-Imaging, P = 0.003; Figure 2D) but delayed groin puncture (Imaging-to-Groin, P < 0.001; Figure 2E), attenuated during weekends (interaction P = 0.034). CT-perfusion use was associated with a 10.2% reduction in Imaging-to-Groin time (P < 0.001; Figure 2E). External transfer showed significantly shorter total intrahospital times (P < 0.001, Figure 2F). Conclusions Interhospital transfers and night-time processing are key optimization targets. Sex-specific delays are restricted to the prehospital recognition phase, whereas intrahospital workflows appear unbiased. The discrepancy between significantly shorter intrahospital times for transferred patients and their overall delay highlights the need for improved allocation concepts to interventional centres. Conflict of interest Max Bieder: Nothing to disclose; Peter Marquardt: Nothing to disclose; Marvin Petersen: Nothing to disclose; Maximilian Schell: Nothing to disclose; Thies Ingwersen: Nothing to disclose; Bastian Cheng: Nothing to disclose; Götz Thomalla: Nothing to disclose; Eckhard Schlemm: Nothing to disclose. Figure 1 - belongs to Methods Figure 2 - belongs to Results