Early treatment via mobile stroke units yields better outcomes vs. ‘drip and ship’
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Among patients with stroke who presented early after symptom onset, those treated by a mobile stroke unit were more functionally independent at 90 days compared with those treated with the “drip and ship” method, researchers reported.
Secondary transfer to a comprehensive stroke center after diagnostic workup (drip and ship) was also associated with poorer NIH Stroke Scale (NIHSS) score at hospital discharge compared with treatment from a mobile interventional stroke team (MIST), according to research published in Stroke.
“Less than 50% of Americans have direct access to endovascular thrombectomy, the others must be transferred to a thrombectomy-capable hospital for treatment, often losing over 2 hours of time to treatment,” Johanna T. Fifi, MD, associate professor of neurosurgery, neurology and radiology in the department of neurosurgery at the Icahn School of Medicine at Mount Sinai, said in a press release. “Every minute is precious in treating stroke, and getting to a center that offers thrombectomy is very important. The MIST model would address this by providing faster access to this potentially lifesaving, disability-reducing procedure.”
Researchers utilized data from the NYC MIST trial and a prospectively collected stroke database to evaluate the impact of a MIST model compared with a drip-and-ship model on the primary endpoint of modified Rankin Scale (mRS) score of 0 to 2 (functional independence) at 90 days. The secondary endpoints included median NIHSS score and mRS score at hospital discharge. The mobile stroke team included a neurointerventionalist, a fellow in training or physician assistant and a radiologic technologist.
Patients were stratified to the early presentation group if they were last known well up to 6 hours before presentation. Patients who presented later than 6 hours after symptom onset were stratified to the late presentation group.
Mobile stroke unit vs. drip and ship
From January 2017 to February 2020, 226 patients who underwent endovascular thrombectomy were included.
Researchers observed that among patients who presented in the early window and were treated by a MIST model, 54% had an mRS score of 0 to 2 at 90 days compared with 28% of patients in the drip-and-ship model (P < .01); however, outcomes were similar among patients in the late presentation group (mobile, 35%; drip and ship, 41%; P = .77).
Median NIHSS score at discharge among patients in the early presentation group was 5 among those treated in the MIST group and 12 among patients in the drip-and-ship group (P < .01).
Median NIHSS score at discharge among patients in the late presentation group was 5 among those treated in the MIST group and 11 among patients in the drip-and ship-group (P < .11).
Among patients who presented early, mRS score at discharge was better in those treated by MIST compared with drip and ship (P < .01), but was similar between the groups for patients who presented late (P = .41), according to the study.
‘Time is brain’
“This study stresses the importance of ‘time is brain,’ especially for patients in the early time window. Although the study is limited by the observational, retrospective design and was performed at a single integrated center, the findings are provocative,” Louise McCullough, MD, American Heart Association/American Stroke Association chair of the International Stroke Conference, chair of the department of neurology at McGovern Medical School at The University of Texas Health Science Center at Houston and chief of neurology service at Memorial Hermann Hospital – Texas Medical Center, said in the release. “The use of a MIST model highlights the potential benefit of early and urgent treatment for patients with large vessel stroke. Stroke systems of care need to take advantage of any opportunity to treat patients early, wherever they are.”
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