Mobile Interventional Stroke Team Model Improves Early Outcomes in Large Vessel Occlusion Stroke

Abstract

Background and Purpose: Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center (TSC) to perform endovascular therapy. Our aim is to determine whether the MIST model is more time-efficient and leads to improved clinical outcomes compared with standard drip-and-ship (DS) and mothership models. Methods: This is a prospective observational cohort study with 3-month follow-up between June 2016 and December 2018 at a multicenter health system, consisting of one comprehensive stroke center, 4 TSCs, and several primary stroke centers. A total of 228 of 373 patients received endovascular therapy via 1 of 4 models: mothership with patient presentation to a comprehensive stroke center, DS with patient transfer from primary stroke center or TSC to comprehensive stroke center, MIST with patient presentation to TSC and MIST transfer, or a combination of DS with patient transfer from primary stroke center to TSC and MIST. The prespecified primary end point was initial door-to-recanalization time and secondary end points measured additional time intervals and clinical outcomes at discharge and 3 months. Results: MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes ( P <0.01). MIST and mothership had similar median door-to-recanalization times of 192 minutes and 179 minutes, respectively ( P =0.83). A greater proportion had a complete recovery (National Institutes of Health Stroke Scale of 0 or 1) at discharge in MIST compared with DS (37.9% versus 16.7%; P <0.01). MIST had 52.8% of patients with modified Rankin Scale of ≤2 at 3 months compared with 38.9% in DS ( P =0.10). Conclusions: MIST led to significantly faster initial door-to-recanalization times compared with DS, which was comparable to mothership. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03048292.

Risk Factors of Recurrent Stroke in Young and Middle-Aged Stroke Patients after Interventional Therapy

“…The effect of cholesterol levels on stroke has been illustrated by many studies. The Framingham Heart Study in the United States has shown that cholesterol levels are positively correlated with atherosclerosis [ 24 ]. For stroke patients of any age, elevated high-density lipoprotein increases the incidence of stroke and high-density lipoprotein levels are parallel to cholesterol levels, so high cholesterol levels often mean high oxidized high-density lipoprotein levels.…”

European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management

“…Despite many efforts to speed up and optimise acute stroke patient management, still only 0.8-1.3% of acute ischaemic stroke (AIS) patients receive their intravenous thrombolysis (IVT) within the so-called golden hourthe first 60 min after symptom onset, when chances of full recovery are highest. 1,2 Many reports on stroke scales, [3][4][5][6][7] emergency medical service (EMS) training and educational programmes, [8][9][10][11][12] structured EMS pre-notification to hospital stroke teams, [13][14][15] emergency department streamlining [16][17][18][19][20] and different triage pathways (mothership vs drive the doctor vs drip and ship) [21][22][23][24][25][26][27][28][29][30][31] have all demonstrated an improvement of treatment numbers and times, but timely delivery of the available and highly beneficial reperfusion therapies [IVT and mechanical thrombectomy (MT)] to AIS patients is still underachieved. Furthermore, delays in onset to treatment times correlate to longer bolus to reperfusion times in AIS patients with proximal intracranial occlusions treated with IVT.…”

Temporal trends in reperfusion therapy for patients with acute ischemic stroke

“…2 In a recent study, a Mobile Interventional Stroke Team (MIST) model was assessed as an alternative model to transferring patients and demonstrated that transferring a MIST to a Thrombectomy Capable Stroke Center to perform endovascular therapy was time efficient. 13 The PHANTOM study in Berlin demonstrated that the use of an ambulance‐based CT scanner followed by thrombolysis was safe and significantly increased the thrombolysis rate (32.6% vs 21% for standard care) and reduced the alarm‐to‐treatment time by a mean of 25 minutes. 14 The second solution could be to reduce the DTN time via a further decrease in the DIT, which was still longer than 25 minutes for more than half of the patients.…”