Mobile Interventional Stroke Teams Improve Outcomes in the Early Time Window for Large Vessel Occlusion Stroke

Endovascular thrombectomy for large vessel occlusion stroke is a time-sensitive intervention. The use of a Mobile Interventional Stroke Team (MIST) traveling to Thrombectomy Capable Stroke Centers to perform endovascular thrombectomy has been shown to be significantly faster with improved discharge...

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Bibliographic Details
Published in:Stroke (1970) 2021-09, Vol.52 (9), p.e527-e530
Main Authors: Morey, Jacob R., Zhang, Xiangnan, Marayati, Naoum Fares, Matsoukas, Stavros, Fiano, Emily, Oxley, Thomas, Dangayach, Neha, Stein, Laura K., Fara, Michael G., Skliut, Maryna, Kellner, Christopher, De Leacy, Reade, Mocco, J, Tuhrim, Stanley, Fifi, Johanna T.
Format: Article
Language:English
Subjects:
Brain Ischemia - therapy
Early Medical Intervention - methods
Endovascular Procedures - methods
Humans
Ischemic Stroke - therapy
Recovery of Function - physiology
Stroke
Thrombectomy - methods
Time-to-Treatment
Treatment Outcome
Vascular System Injuries - therapy
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Summary:Endovascular thrombectomy for large vessel occlusion stroke is a time-sensitive intervention. The use of a Mobile Interventional Stroke Team (MIST) traveling to Thrombectomy Capable Stroke Centers to perform endovascular thrombectomy has been shown to be significantly faster with improved discharge outcomes, as compared with the drip-and-ship (DS) model. The effect of the MIST model stratified by time of presentation has yet to be studied. We hypothesize that patients who present in the early window (last known well of ≤6 hours) will have better clinical outcomes in the MIST model. The NYC MIST Trial and a prospectively collected stroke database were assessed for patients undergoing endovascular thrombectomy from January 2017 to February 2020. Patients presenting in early and late time windows were analyzed separately. The primary end point was the proportion with a good outcome (modified Rankin Scale score of 0-2) at 90 days. Secondary end points included discharge National Institutes of Health Stroke Scale and modified Rankin Scale. Among 561 cases, 226 patients fit inclusion criteria and were categorized into MIST and DS cohorts. Exclusion criteria included a baseline modified Rankin Scale score of >2, inpatient status, or fluctuating exams. In the early window, 54% (40/74) had a good 90-day outcome in the MIST model, as compared with 28% (24/86) in the DS model (
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.121.034222