Lancet Neurology

Every minute matters: Faster interhospital transfers linked to better stroke outcomes

January 26, 2026

In a U.S. retrospective cohort of 22,410 patients with acute ischemic stroke transferred for endovascular therapy evaluation, median door‑in–door‑out (DIDO) time was 121 minutes. Although 75.8% of patients ultimately received endovascular therapy, longer DIDO times were progressively associated with worse outcomes. Compared with ≤90 minutes, DIDO times of 91–180, 181–270, and >270 minutes were associated with higher odds of worse discharge modified Rankin Scale (mRS) scores (adjusted odds ratios, 1.29, 1.49, and 1.70, respectively) and substantially lower odds of receiving thrombectomy. Longer delays were also associated with reduced independent ambulation and more post‑reperfusion complications.

Clinical takeaway: After imaging, prioritize rapid transfer workflows. Aim for DIDO ≤90 minutes to maximize thrombectomy access and functional recovery.

Source:

Royan, R et al. (2026, February). Lancet Neurology. Door-in-door-out times and outcomes in patients with acute ischaemic stroke transferred for endovascular therapy in the USA: a retrospective cohort study. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(25)00478-8/abstract.