Wang, Ching-YiChing-YiWangChen, Chi-JenChi-JenChenHsieh, Yi-ChenYi-ChenHsiehLin, Wey-YilWey-YilLinTang, Sung-ChunSung-ChunTangChen, Chih-HaoChih-HaoChenLin, Chun-JenChun-JenLinLin, Kuan-HungKuan-HungLinSung, Pi-ShanPi-ShanSungTang, Chih-WeiChih-WeiTangChu, Hai-JuiHai-JuiChuFu, Chuan-HsiuChuan-HsiuFuChou, Chao-LiangChao-LiangChouWei, Cheng-YuCheng-YuWeiYen, Shang-YihShang-YihYenChen, Po-LinPo-LinChenYeh, Hsu-LingHsu-LingYehSung, Sheng-FengSheng-FengSungHON-MAN LIULin, Ching-HuangChing-HuangLinLee, MengMengLeeLee, I-HuiI-HuiLeeChen, Yu-WeiYu-WeiChenChan, LungLungChanLien, Li-MingLi-MingLienChiou, Hung-YiHung-YiChiouLee, Jiunn-TayJiunn-TayLeeJeng, Jiann-ShingJiann-ShingJeng2026-04-242026-04-242026https://scholars.lib.ntu.edu.tw/handle/123456789/737553Background: The outcome of patients undergoing endovascular thrombectomy (EVT) for large vessel occlusion in a comprehensive stroke center (CSC) is affected by the onset-to-treatment time. Whether the pathway to CSC arrival (direct vs. interhospital transfer) is thus associated with EVT outcomes among such patients is unknown. Methods: Using the Taiwan Registry of Endovascular Thrombectomy for AIS registry, patients ≥20 years of age and receiving EVT for AIS within 24 h of onset between January 2019 and December 2022 were included. Patients were categorized according to CSC arrival pathway into direct arrival and transfer groups. The primary outcome was 3-month functional independence, defined as a modified Rankin Scale (mRS) of 0–2. Results: Of the1830 patients included, 79% arrived at a CSC directly and 21% via transfer. More patients in the direct arrival than the transfer group achieved a 3-month mRS of 0–2. A significant interaction was found between onset-to-puncture (OTP) time and arrival pathway for achieving 3-month mRS 0–2 (p interaction = 0.017). Arrival by transfer was associated with reduced odds of achieving mRS 0–2 when OTP time was < 6 h (aOR, 0.55), but with increased odds when OTP was ≥6 h (aOR, 1.95). Conclusions: Direct arrival was associated with improved outcomes if OTP < 6 h. Patients who arrive via transfer may still benefit substantially from EVT during the later treatment window. Further study is warranted to examine the predictors of favorable post-EVT outcomes within a 24-h window to facilitate timely treatment.entruedirect transportendovascular thrombectomyfunctional outcomeinter-hospital transferischemic strokeonset-to-puncture timejournal article10.3389/fneur.2026.1743928419191332-s2.0-105034497112