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
Arun Subramanian (Fri,) studied this question.