J Neuroendovasc Ther. 2026;20(1):2025-0130. doi: 10.5797/jnet.oa.2025-0130. Epub 2026 Mar 4.
ABSTRACT
OBJECTIVE: Minimizing the time to reperfusion is a critical determinant of the prognosis of acute ischemic stroke (AIS). To reduce the workload of neurosurgeons, improve efficiency, and shorten the time required for AIS management delivered by the neurosurgical department, a nurse practitioner (NP) was introduced in April 2019. However, the effect of NP involvement on post-door-to-needle (D2N) intervals, particularly time to reperfusion, has not been clarified. This study examined whether NP participation was associated with shorter post-D2N time metrics in patients with AIS undergoing mechanical thrombectomy (MT).
METHODS: This study included all consecutive patients with AIS due to intracranial large vessel occlusion who underwent MT between April 2019 and March 2024 at our institution. Patients with NP involvement were assigned to the NP group, and those without NP involvement were assigned to the non-NP group. NP participation was randomly determined according to their duty schedule. The primary outcomes were the median times from angiography suite entry-to-puncture (E2P) and from suite entry-to-recanalization (E2R). Secondary outcomes included onset-to-puncture (O2P), puncture-to-recanalization (P2R), door-to-entry (D2E), door-to-puncture (D2P), and the proportion of patients with a modified Rankin Scale (mRS) score of 0-2 at discharge. Statistical analyses included univariate and multivariate linear regression analysis, with significance set at p <0.05.
RESULTS: In total, 115 patients were included: 44 in the NP group and 71 in the non-NP group. The baseline patient characteristics were comparable. The median E2P was significantly shorter in the NP group (15 vs. 21 min; p <0.05), representing a 6-min reduction (28.6%). The median E2R was 73 vs. 76.5 min, showing a nonsignificant 3.5-min decrease. Among the secondary metrics, D2P was shorter in the NP group, whereas the O2P, P2R, and D2E levels did not differ significantly. In the multivariate linear regression analyses, only E2P remained independently associated with NP involvement. The proportion of patients with favorable outcomes (mRS 0-2) at discharge was higher in the NP group (27.3% vs. 19.7%), although the difference was not significant.
CONCLUSION: NP participation significantly reduced E2P time. These findings suggest that NP involvement contributes to shortening the treatment time in the post-D2N phase and may have a crucial role in promoting efficient team-based care in AIS management.
PMID:41804504 | PMC:PMC12967338 | DOI:10.5797/jnet.oa.2025-0130
