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Background: Increased time from symptom onset to puncture (TSOP) and time from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 h). However, these associations are less described in the late window (>6 h), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes., Methods: The ETIS (Endovascular Treatment in Ischemic Stroke) registry is an ongoing, prospective, observational study in 21 centers that perform EVT in France. We included adult patients with an anterior occlusion, successfully treated by EVT (modified treatment in cerebral ischemia (mTICI) 2b-3) between January 2015 and June 2023, with a known time of stroke onset. The cohort was divided into two groups according to the TSOP (⩽6 h vs >6 h). Primary outcome was favorable outcome (modified Rankin Scale 0-2 at 90 days)., Results: In total, 7516 patients were included, with 5936 patients being treated ⩽6 h and 1580 >6 h. In the early window, TSOP and TPTR were associated with worse outcomes at 90 days (adjusted odds ratio (aOR) = 0.68 per hour; 95% confidence interval (CI) = 0.64-0.73; p  < 0.001 and aOR = 0.92 per 10-min increment; 95% CI = 0.90-0.94, p  < 0.001, respectively). TSOP was not associated with worse outcomes at 90 days in the late window ( p  = 0.955), but TPTR was associated with worse outcomes (aOR = 0.91 per 10-min increment; 95% CI = 0.86-0.96, p  = 0.001), every 10 additional minutes in TPTR being associated with a 1.7% (95% CI = 0.6-2.7) decreased probability of favorable outcome., Conclusion: Only EVT procedural time is associated with unfavorable outcomes at 90 days in late window patients. These results highlight how the late window paradox may end at the start of EVT and underscore the need for timely management, particularly for the EVT, even for late window patients with a presumed more favorable imaging profile., Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: J.-M.O. declares consulting activities with Abbvie, Acticor, and Bioxodes; speaking fees from BMS, Boerhinger Ingelheim; S.F. is the author of a patent (US20200085454A1). B.G. has received grants from the French Ministry of Health and is the primary investigator of the TITAN, DIRECT ANGIO, and IA-RESCUE trial, and consulting fees from Air Liquide, MIVI, Medtronic, Microvention, and Penumbra. M.M. declares consulting fees from Boerhinger Ingelheim, Air Liquide, Acticor Biotech, and Amgen. S.R. declares contracts from Boerhinger Ingelheim France, Bristol-Myers Squibb, and Pfizer SAS.

Objectives: Sialendoscopy is a relatively new minimally invasive technique that permits direct salivary tree visualization and is important in obstructive sialadenitis management and treatment. The present study aimed to examine the sialendoscopy learning curve between March 2009 and March 2013., Methodology: We compared the first and last 100 sialendoscopies performed in our department with regard to anaesthesia type, operating time, success rate, technical difficulty, major complications, and clinical improvement., Results: General anaesthesia rates were 63% and 38% (P = 0.0004) among the first and last 100 sialendoscopies, respectively. Among the first and last 100 procedures, respectively, average operating times were 39 and 25 minutes (P = 0.00055) for diagnostic sialendoscopies and 68 and 65 minutes (P = 0.35) for interventional sialendoscopies. Successful stone extraction rates were 65% and 90.2% (P = 0.0058) among the first and last 100 procedures, respectively, while the corresponding rates of successful stenosis dilation were 92.5% and 97.1% (P = 0.27). Technical difficulty was encountered in 25% and 17% (P = 0.164) of the first and last 100 sialendoscopies, respectively. Neither group experienced major complications. All patients tolerated the procedures well and had excellent outcomes., Conclusion: Progressive learning regarding sialendoscopy enabled more frequent operation under local anaesthesia, thus better meeting the requirements of a minimally invasive technique. We were able to decrease the operative time in diagnostic sialendoscopy. These two factors support the inclusion of diagnostic sialendoscopy into the diagnostic panel in obstructive glandular diseases.