Time to Reperfusion: A Cost-of-Delay Analysis in Endovascular Stroke Treatment

The publication titled “Healthy Life-Year Costs of Treatment Speed From Arrival to Endovascular Thrombectomy in Patients With Ischemic Stroke” presents a meta-analysis of individual patient data from seven randomized clinical trials involving 406 adults. The study quantifies the impact of in-hospital treatment speed on long-term health outcomes for patients undergoing endovascular thrombectomy (EVT) following acute ischemic stroke due to large-vessel occlusion.

Key findings reveal that every second of delay from hospital arrival to EVT initiation results in a loss of approximately 2.2 hours of healthy life, while each second to reperfusion corresponds to a 2.4-hour loss. These metrics underscore the critical importance of rapid in-hospital workflows. Patients treated within four hours of stroke onset were particularly sensitive to delays, with each 10-minute delay costing an estimated 1.8 months of healthy life. Even patients treated later (between 4 and 12 hours post-onset) experienced significant reductions in healthy life-years, reinforcing the urgency of timely intervention across all treatment windows.

The study employed Disability-Adjusted Life Years (DALYs) to measure outcomes, combining years lost due to premature death and years lived with disability. Time intervals analyzed included last known well to hospital arrival, arrival to arterial puncture, and arrival to reperfusion. Among these, door-to-puncture time emerged as the most reliable predictor of outcome due to its precision and relevance to fast-progressing strokes.

The findings have strong implications for stroke care systems. Hospitals are encouraged to optimize emergency department workflows through strategies such as pre-notification, rapid imaging, and direct-to-angiography protocols. These improvements align with initiatives like the American Heart Association’s Target: Stroke III, which promotes best practices to reduce door-to-treatment times.

In conclusion, the study provides compelling evidence that every minute counts in stroke care. Reducing in-hospital delays can significantly improve patient recovery and long-term quality of life, making workflow optimization a critical priority for healthcare providers.

Author: SYNYO GmbH

Sources: “Healthy Life-Year Costs of Treatment Speed From Arrival to Endovascular Thrombectomy in Patients With Ischemic Stroke”, JAMA Network, May 3 2021, https://jamanetwork.com/journals/jamaneurology/fullarticle/2779592 , Accessed on 21.10.2025