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Background Trained advanced practice providers (APPs) may facilitate mechanical thrombectomy (MT) for ischemic stroke by efficiently navigating pre-procedural processes and providing intraprocedural assistance. We explored the effect of in-house cerebrovascular APPs on MT timing.Methods A prospectively maintained registry of patients undergoing MT for AIS at a single comprehensive stroke center (CSC) was reviewed for cases occurring between 1/1/2017 to 12/31/2024 and classified by the presence of an assisting APP. Overnight cases were defined by presentation to hospital from 21:00-07:00.Findings A total of 2,122 patients underwent MT during the study period. An APP was present in 1,177/1679 (70%) of daytime and 313/607 (52%) of overnight cases. The daytime and overnight cohorts were well-matched across baseline characteristics including pre-procedural MRI performance (10%), excepting higher OSH transfer rates (p=0.013) in the -APP group overnight. Overnight, +APP cases had lower median discharge NIHSS (4 vs. 6.5, p=0.018) and more favorable discharge disposition (p=0.019), though rates of good neurological outcomes (mRS≤2) at 90-days were similar. In lognormal regression models adjusting for transfer status and pre-procedural MRI, APP presence was associated with an 8% reduction in arrival-to-angio time (TR 0.92, [95%CI 0.88-0.97], p=0.001) and a 5% reduction in arrival-to-recanalization time (TR 0.95, [95%CI 0.91-0.99], p=0.020). OSH transfer was associated with shorter door-to-angio and door-to-recanalization times (p<0.001), while pre-procedural MRI was associated with prolonged times (p<0.001).Overall, puncture-to-recanalization time did not differ significantly based on APP presence after adjusting for pass count (TR 1.02, [95%CI 0.92-1.12], p=0.75), though each additional pass was associated with a 41% increase in time (TR 1.41, 95%CI 1.35-1.48, p<0.001), with a non-significant trend toward APP benefit at higher pass counts (interaction TR 0.96, [95%CI 0.91-1.00], p=0.077). Among multi-pass cases (n=772), APP availability was associated with a 34% reduction in time from first pass to successful recanalization (TR 0.66, [95%CI 0.49-0.87], p=0.003).Conclusions The presence of in-house cerebrovascular APPs facilitated faster arrival-to-puncture and arrival-to-recanalization times. Effects were most pronounced in overnight cases presenting directly to CSC and in multi-pass cases.Disclosures G. Paolucci: None. K. Quinn: None. J. Feler: None. C. Doberstein: None. K. Moldovan: None. E. Shaaya: None. Z. Zhong: None. Z. Jiao: None. R. Torabi: None.Abstract O-046 Figure 1Abstract O-046 Table 1Daytime, -APPDaytime, +APPp valueOvernight, -APPOvernight, + APPp valueArrival to angio — RIH, median (IQR)70 (37)68 (32)0.3093 (34)85 (34)0.01Arrival to angio — Transfer, median (IQR)26 (38)21 (26)0.0421 (22)23 (28)0.43Puncture to 1st deployment, median (IQR)14 (11)14 (11)0.6914 (11)15 (10)0.27Recanalization time, median (IQR)22 (20)22 (19)0.3122 (18)21 (16)0.58Arrival to recan — RIH, median (IQR)97 (50)94 (46)0.17118 (35)110 (35)0.14Arrival to recan — Transfer, median (IQR)55 (48)50 (47)0.2952 (45)49 (58)0.98Favorable Discharge (Home or ARF), n (%)234 (60.5%)750 (63.7%)0.25140 (57.1%)210 (67.1%)0.016mRS 0-2 at 90d, n (%)131 (36.0%)390 (34.9%)0.7280 (33.9%)123 (41.1%)0.09