Background: Direct To Angio (DTA) for transferred large vessel occlusions (LVO) lowers time to endovascular thrombectomy (EVT), reperfusion and potentially improves outcomes. Safety and efficacy of DTA in late time window and on-call hours is unknown. Methods: Pooled cohort from 6 centers (EU, US) from 1/14-5/20 (ICA, M1, M2) LVO pts transferred for EVT≤24 hrs from LKW. Pts stratified into with repeat imaging (RI) (CT+/- CTA/CTP) and without RI (DTA). We compared time metrics, good outcome (90 day mRS 0-2), safety (sICH, mortality) and assessed the impact of arrival for EVT; regular (M-F, 8am-5pm) vs on-call hrs. Propensity matched analysis was done. Results: Of 1178 EVT transfers, 334 (28%) were DTA. DTA pts had more tPA (61% vs 51%, p=0.002), trended to lower NIHSS 17 (12, 20) vs 17 (13, 21), p=0.07 and lower LKW to arrival 268 (190, 430) min vs 280 (190, 518), p=0.097. Groin puncture (GP) was faster with DTA (p<0.001) Fig 1. Good outcomes were higher with DTA overall (53% vs 38%, aOR 1.7, 95%CI 1.3-2.4, p=0.001), regular (54% vs 41%, p=0.07) and on-call hrs (52% vs 36%, p=0.008), mortality was lower overall (17% vs 24%, p=0.04) and all hrs Fig 2 A-C. sICH rates were similar. A 10 min increase arrival to GP with RI correlated to 5% reduction in good outcome odds (aOR 0.95, 95%CI 0.91-0.99, p=0.01). The results did not vary by time window (0-6 hrs vs >6-24, p=0.88 for interaction). In propensity matched 75 pairs, DTA had shorter time to EVT (19 min vs 52, p<0.001) and higher mRS 0-2 (55% vs 32%, aOR 4.8 (1.9-12.4), p=0.001) fig 2D. However, the probability of mRS 0-2 decreased with increasing transfer times in DTA pts (< 3 hrs 59% vs 36% ≥ 3 hrs, p<0.001) but not in RI (36% vs 37%, p=0.88) fig 3. Conclusion: In pooled, non-randomized data DTA may result in faster treatment, safe and better functional outcomes, during all hours and treatment windows. Repeat imaging may be reasonable with prolonged transfer times. Optimal EVT workflow in transfers may result in faster, safe reperfusion with higher good outcomes.