Improving Stroke Outcomes Through Mobile Care, At Least in New York City

Bret Stetka, MD

Disclosures

May 16, 2019

Lili Velickovic

Mobile stroke care is increasingly being used to get patients suffering from cerebrovascular events treated more quickly, with the goal of improving clinical outcomes. While attending the American Academy of Neurology (AAN) 2019 Annual Meeting, Medscape interviewed Lili Velickovic Ostojic, MD, neurology chief resident at Mount Sinai Beth Israel hospital in New York City, about her recent study on how mobile, interventional healthcare teams can help to more effectively treat stroke.

What is the role of Mount Sinai's mobile interventional stroke team?

The Mobile Interventional Stroke Team, or MIST, is based at Mount Sinai hospital and travels to three other sites within our health system to perform mechanical thrombectomy in patients with stroke due to large vessel occlusion (LVO). The traveling team consists of a neurointerventional surgeon, a fellow, and a specialized neurointerventional technologist. They are alerted as soon as there is suspicion for LVO at any of the sites and travel there immediately, either by taxi or public transportation. In this way, we are able to get the team to the patient instead of transporting the patient to the team, and this minimizes the time lost in patient transfer. Each of the individual sites is fully equipped for thrombectomies to be performed once the team has arrived.

Can you briefly summarize the study that you and your colleagues are presenting here at AAN?

In our study,[1] we looked at patients with an LVO presenting to one specific site within our healthcare system. We wanted to investigate whether outcomes differ for patients transferred from Mount Sinai Beth Israel to a different site for thrombectomy, compared with those who stayed and were treated onsite by a MIST. We already knew from a prior study, published in 2017,[2] that the utilization of a MIST leads to shorter time to thrombectomy, and we were interested to see whether we could identify any difference in outcome as well.

What did you find?

Our study confirmed that using a MIST leads to significantly shorter time to thrombectomy. Door-to-puncture time in patients treated onsite by a MIST was, on average, 140.5 minutes, compared with 233 minutes for patients who were transferred. We saw a trend of complete recanalization being achieved more frequently in the MIST group, but this did not reach statistical significance. We were not able to demonstrate a significant difference in functional independence on 90-day follow-up between the groups, although we were limited by the small number of patients included in the study.

Do you feel that geography influenced your results? How might the findings have been different in a less populated region of the country?

Geography probably does play a role in our results. This study was set in a large, urban-based integrated stroke network and might be difficult to apply outside of a metropolitan setting. Several factors need to be considered in order for this type of system to be implemented—for example, distance between sites and credentialing of team members at all sites involved. In a less populated area with less neurointerventional capacity, it would probably be challenging to mobilize a team without the ability for a backup team to handle any simultaneous cases at a different site.

Do you have any follow-up research planned?

There is an ongoing, larger study at our institution, looking at outcomes at all sites covered by the MIST. We hope the results will continue to guide us toward the best possible management of patients with LVO.

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