Time Metrics of Acute Stroke Pathways for Mechanical Thrombectomy in Indonesia: A Descriptive Study on Two Tertiary Major Hospitals

Background: Mechanical thrombectomy (MT) is a time-sensitive reperfusion treatment for acute ischemic stroke caused by large-vessel occlusion. Workflow time metrics for MT remain poorly characterized in Indonesia, where stroke burden is substantial. This study describes pre-hospital and in-hospital time-interval metrics for MT across two major tertiary hospitals in Jakarta and evaluates institutional trends over a nine-year period. Methods: We conducted a retrospective descriptive study of consecutive patients undergoing MT at dr. Cipto Mangunkusumo National General Hospital (RSCM) and Prof. Dr. dr. Mahar Mardjono National Brain Center Hospital (RSPON) from 2017 to 2025. Pre-hospital and in-hospital time-interval metrics were reported as median (interquartile range [IQR]) and stratified by institution. Results: Among 330 registered patients, 71 were excluded due to incomplete data, leaving 259 in the final cohort (RSCM n=38; RSPON n=221). The pooled cohort had a mean age of 58.12 {+/-} 11.09 years; 63.71% were male. Hypertension was the most prevalent vascular risk factor (53.67%). Median door-to-CT time was 9 minutes (IQR 18), door-to-decision 101 minutes (IQR 100), and door-to-groin puncture 272 minutes (IQR 152). Total ischemic time (onset-to-groin puncture) was 468 minutes (IQR 294). MT volume increased substantially over the study period, particularly after 2022 at RSPON, which also demonstrated progressive improvement in in-hospital workflow times. RSCM showed increasing delays in later years, consistent with institutional congestion at a general multispecialty center. Conclusions: Early brain imaging was achievable at both centers; however, post-imaging delays particularly in CT-to-groin intervals, represent the dominant in-hospital bottleneck. Future quality-improvement efforts should prioritize decision-making, team mobilization, and pre-hospital coordination to reduce total ischemic time and improve access to reperfusion therapy.