Impact of prehospital scene-to-door time on functional outcomes after endovascular thrombectomy: insights from a regional stroke network

Minimizing time to endovascular thrombectomy (EVT) is crucial for the treatment of acute ischemic stroke (AIS). While prehospital transport interval is widely used to describe the overall ambulance transfer process, the prognostic relevance of scene-to-door time (SDT)—the interval from departure at the emergency scene to hospital arrival—remains unclear. This study aimed to examine the association between SDT and 90-day functional outcomes after EVT, with focus on the modifying role of pre-stroke disability. We retrospectively analyzed patients who underwent EVT at a single comprehensive stroke center between 2018 and 2023. Time metrics, including the onset-to-door time, onset-to-recanalization time, and SDT, were collected. Pre-stroke disability (modified Rankin Scale [mRS] ≥ 1) was assessed as a potential effect modifier. The receiver operating characteristic (ROC) curve was analyzed to determine the discriminative ability of SDT for 90-day favorable clinical outcome (mRS ≤ 3). Of the 176 patients who underwent EVT for AIS during the study period, 121 were directly transported from the scene and included in the final analysis. In the overall direct-transport cohort, SDT showed a modest but non-significant association with favorable clinical outcomes (area under the curve [AUC] = 0.57). In patients with pre-stroke disability, SDT demonstrated moderate discrimination (AUC = 0.76) with an optimal cutoff of 14 min. In multivariable logistic regression analyses adjusted for age, sex, baseline National Institutes of Health Stroke Scale (NIHSS), and use of intravenous thrombolysis (IVT), increasing SDT was independently associated with lower odds of favorable clinical outcomes in patients with pre-stroke disability (adjusted odds ratio 0.91, 95% confidence interval 0.81–0.98). SDT showed limited discriminative performance for functional outcomes across the overall EVT cohort but demonstrated moderate discrimination among patients with pre-stroke disability. SDT may reflect certain aspects of regional transport efficiency within stroke care systems.