<![CDATA[Acute ischemic stroke requires timely reperfusion, yet treatment delays remain a challenge in urban referral systems. This retrospective cohort study evaluated factors associated with onset-to-groin puncture time among 204 patients with acute ischemic stroke who underwent mechanical thrombectomy at a national brain center hospital in Jakarta, Indonesia. Clinical, geographic, administrative, and time-related variables were analyzed using non-parametric tests and multivariable linear regression. The median onset-to-groin puncture time was 455 minutes, with an interquartile range of 236.8 minutes. Hospital referral was independently associated with longer delays, with an adjusted delay of approximately 111 minutes compared with non-referred patients. Private insurance payment was also associated with a longer delay, but this finding should be interpreted with caution because only four patients were included in this subgroup. Residential distance and arrival outside office hours showed non-significant trends, while age, sex, baseline stroke severity, residential region, public health center referral, out-of-pocket payment, and cost-sharing payment were not independently associated with delay. These findings indicated that the onset-to-groin puncture delay in this urban referral cohort was driven primarily by interhospital referral and administrative pathway rather than by the measured clinical or geographic characteristics.]]>
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