Abstract Number: Esoc2026a852 Bypassing Primary Stroke Centres for Thrombectomy-Capable Centres Improves Functional Outcomes: A Systematic Review and Meta-Analysis

Abstract Background and aims The efficacy of endovascular thrombectomy (EVT) for acute ischaemic stroke due to large vessel occlusion (LVO) is time-dependent. Patients initially transported to primary stroke centres may require secondary transfer, potentially delaying EVT. However, bypassing the closest stroke centre to expedite EVT may delay intravenous thrombolysis (IVT). Among patients not living closest to a thrombectomy-capable centre, we assessed whether direct transport to such centres improves functional outcomes compared with transport to the nearest stroke centre. Methods This systematic review was registered with PROSPERO (CRD420251276150) following PRISMA guidelines. We searched PubMed and Web of Science until December 2025 for studies comparing transport to the nearest stroke centre or a more distant thrombectomy-capable center. We included randomised and non-randomised studies reporting functional outcomes, reperfusion therapy rates, or time metrics. Random-effects meta-analysis quantified associations between bypass strategies and outcomes. Results Across 16 studies with 13,010 patients, pre-hospital bypass strategies were associated with higher rates of EVT (OR 1.69, 1.22 – 2.34) and shorter time-to-groin-puncture (-50.74 min, -69.86 – -31.61). IVT rates (OR 1.14, 0.93 – 1.40) and time-to-needle (0.45 min, -8.09 – 8.99) did not differ between groups. Functional independence at 90 days was more frequent in bypass patients (mRS 0 – 2: OR 1.23, 1.07 – 1.41), while severe disability or death (mRS 4 – 6) was less frequent (OR 0.81, 0.67 – 0.98). Conclusions Pre-hospital bypass strategies were associated with increased EVT rates and reduced time-to-groin-puncture without compromising IVT delivery, translating into better functional outcomes and less disability. These findings support pre-hospital bypass protocols for patients not residing nearest to thrombectomy-capable centres. Conflict of interest Thies Ingwersen: nothing to disclose. Patrick Eder : nothing to disclose. Raphael Bourry: nothing to disclose. Jan P Marquardt: nothing to disclose. Jenna Schellin: nothing to disclose. Bastian Cheng: nothing to disclose. Götz Thomalla received consultancy fees from Acandis, Boehringer Ingelheim, Bayer, and Portola, and fees as lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO. Eckhard Schlemm: nothing to disclose. Figure 1 - belongs to Methods Figure 2 - belongs to Results Figure 3 - belongs to Results