ESOC 2026 | Door-in-door-out times and outcomes in patients with AIS transferred for EVT

We all know that we have major efficacious treatments for acute ischemic stroke from a large vessel occlusion. So endovascular therapy is one of the most efficacious treatments in modern medicine. We also know that these therapies are really time-dependent and unfortunately many patients with stroke end up presenting or arriving at facilities that can’t give endovascular thrombectomy. And so this requires inter-hospital transfer of the patient from the first presenting hospital to another more resourced hospital. So an important metric that’s emerging is called door-in-door-out time, which is the amount of time it takes to transfer the patient from that first hospital, the amount of time they spend in that first hospital. Our prior research, largely from data within the U.S., has shown that these times in door-in-door-out time or DITO time tend to be very prolonged compared to what they should be. And you would imagine that these prolonged transfer times may lead to worse clinical outcomes, but actually the data so far on this has been rather mixed and has largely consisted of single-center small studies. So what we sought to do in this recent publication in Lancet Neurology from February of this year was to look at the largest national registry stroke data within the United States, the Get With The Guidelines Stroke Registry. And we selected for patients who had a visualized target occlusion lesion and were being transferred from an initial hospital to another hospital for consideration of EVT, endovascular therapy. And what we found in over 20,000 patients in this registry was that prolonged door-in-door-out times was strongly associated with a variety of things, including lower rates of endovascular therapy, worse complications, and worse functional outcomes. So really, this provides now compelling and fairly comprehensive data that we as a system of care should be prioritizing reducing these door-in-door-out times both within our own nations and globally because I think that this will really have a major impact on patient outcomes.

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