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Introduction Inter-hospital transfer delays from primary stroke centers (PSCs) to comprehensive stroke centers (CSCs) critically impact thrombectomy outcomes. Door-in-door-out (DIDO) time is a key bottleneck. The PITSTOP protocol addresses this by having the initial ambulance crew wait during PSC assessment and perform the immediate transfer to the CSC using the same crew if thrombectomy is indicated.Aim of Study A previously published pilot study from our group confirmed significant DIDO reduction with PITSTOP. We aimed to evaluate clinical outcomes following its broader implementationMethod We retrospectively analyzed 1,522 consecutive patients referred for thrombectomy (2020–2024). Patients undergoing PITSTOP protocol (n=158) were compared with non-PITSTOP patients (n=1,404). Primary outcomes were modified Rankin Scale (mRS) scores at 30 and 90 days. Adjusted analysis included age and baseline NIHSS scores. Secondary outcomes were procedural safety (intraprocedural hemorrhage).Results Median mRS scores at day 90 were better in the PITSTOP group (2 vs. 3, p=0.052). After adjusting for age and baseline stroke severity (NIHSS), participation in PITSTOP significantly improved outcomes at 90 days (β=-0.38, p=0.042). Age and baseline NIHSS independently predicted worse outcomes (p<0.001). There was no significant difference in mRS at 30 days (median 3 in both groups, p=0.095). There were no differences in safety outcomes between the two groups.Conclusion Broader implementation of the PITSTOP protocol significantly improved clinical outcomes at 90 days, after adjustment for key confounders, without adversely affecting procedural safety. These findings strongly support PITSTOP as a safe and effective strategy to enhance thrombectomy workflows and outcomes.Conflict of Interest No