Longer Door-in-Door-Out Times Linked to Lower Rates of Endovascular Therapy

TUESDAY, Jan. 27, 2026 (HealthDay News) — For patients with acute ischemic stroke, longer door-in-door-out (DIDO) times are associated with lower rates of endovascular therapy and higher rates of complications, according to a study published in the February issue of The Lancet Neurology.

Regina Royan, M.D., M.P.H., from the University of Michigan in Ann Arbor, and colleagues conducted a retrospective cohort study of patients with acute ischemic stroke and a visualized target occlusion on cerebrovascular imaging who were transferred from acute care hospitals to hospitals within the U.S. nationwide Get With The Guidelines–Stroke registry for endovascular therapy evaluation. The primary outcome was ordinal modified Rankin Scale (mRS) score at hospital discharge.

The researchers found that the median DIDO time was 121 minutes among the 22,410 patients with acute ischemic stroke transferred for endovascular therapy evaluation. In 75.8 percent of patients, endovascular therapy was performed at the receiving hospital. Longer DIDO times were associated with higher odds of a 1-point increase in mRS score at discharge compared with 90 minutes or less (adjusted odds ratios, 1.29, 1.49, and 1.70 for 91 to 180, 181 to 270, and >270 minutes, respectively) and with lower odds of endovascular therapy receipt (0.71, 0.50, and 0.35 for 91 to 180, 181 to 270, and >270 minutes, respectively). There was also an association for longer DIDO times with reduced independent ambulation and increased complications after reperfusion therapy.

“We need to be paying greater attention to developing efficiencies within regional stroke systems of care with a targeted focus on minimizing door-in-door-out times,” coauthor Brian Stamm, M.D., also from the University of Michigan in Ann Arbor, said in a statement.

One author disclosed ties to the biopharmaceutical industry.

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