Extern procedure time is an important quality marker for patients with an acute ischemic stroke who are transferred for endovascular therapy (EVT). We sought to determine whether the door-in-door-out time in spoke hospitals is associated with the performance of EVT at the hub site and functional outcome in a stroke-network. We analyzed consecutive patients (01/2016 to 12/2018) from our prospective database who had an acute proximal anterior circulation large vessel occlusion (acLVO) and were transferred to our neurovascular center to be screened for potential EVT. We determined door-in-door-out times at the referring hospitals and analyzed their association with the percentage of patients in whom EVT was performed after repeated imaging at our center and 90-days favorable functional outcome (mRS scores 0-2). Of 360 patients (median age 76 years, 48% female, median NIHSS score 17) who were transferred from remote hospitals for potential EVT, the median door-in-door-out time was 110 minutes (IQR; 49). Among 184 patients with door-in-door-out-time ≤110 minutes (median time 87 minutes, IQR 27), 112 patients (60.9%) underwent EVT and 56 patients (30.4%) had a favorable outcome. The EVT rate (96/176; 54.5%) and percentage of patients with a favorable outcome (58/176; 33%) was similar among patients with a door-in-door-out time >110 minutes (p=0.24 and p=0.65, respectively). Door-in-door-out time was not associated with EVT-rate and favorable functional outcome in patients who were transferred for potential EVT in our stroke network.
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