Door-to-needle time in acute ischemic stroke: Impact of imaging pathway on thrombolysis workflow—A single-center audit

Abstract

Background: Rapid reperfusion is the cornerstone of acute ischemic stroke (AIS) management. Door-to-needle time (DTN) is a key quality metric and is strongly timedependent for benefit from intravenous thrombolysis. Imaging workflow can substantially influence DTN.

Objective: To evaluate DTN performance in AIS patients treated with intravenous thrombolysis and compare DTN between CT-based and MRI-based imaging pathways.

Methods: Retrospective audit of consecutive adult AIS patients who received intravenous thrombolysis at a tertiary stroke center. Demographics, vascular risk factors, stroke territory, imaging pathway (CT-first vs MRI-first), and DTN were recorded. Results are presented descriptively with comparison of mean DTN across pathways.

Results: Forty patients underwent thrombolysis; 23 (57.5%) were male. Anterior circulation strokes comprised 35/40 (87.5%). Major risk factors included hypertension 22/40 (55%), diabetes 16/40 (40%), smoking 17/40 (42.5%), and dyslipidemia 14/40 (35%). Mean DTN was 41 minutes in the CT-based pathway versus 66 minutes in the MRI-based pathway (absolute delay 25 minutes with MRI-first).

Conclusion: A CT-first workflow was associated with substantially shorter DTN compared with MRI-first imaging in our real-world audit. CT-first imaging should remain the default strategy for eligible hyperacute stroke patients, while MRI-first pathways should be reserved for selected indications (e.g., unclear onset) to avoid reperfusion delays.