Mobile Stroke Units Speed Time to Intraarterial Thrombectomy

By Reuters Staff

July 02, 2019

NEW YORK (Reuters Health) - Evaluation in a mobile stroke unit (MSU) shortens time to intraarterial thrombectomy (IAT) compared with standard evaluation by emergency medical services (EMS), according to new findings.

"Our study is the first to demonstrate improved DTPT (door-to-puncture time) in patients brought directly to the ED via an MSU versus EMS," Dr. Alexandra L. Czap of the University of Texas Health Science Center in Houston and colleagues write in Stroke, online June 11. "This finding was consistent among patients who did and did not receive tPA (tissue-type plasminogen activator), regardless of adjudication criteria."

The findings are a substudy of the ongoing BEST-MSU trial, in which tPA-eligible patients with acute ischemic stroke (AIS) are randomized week-by-week to management in a MSU or standard care by EMS. In the MSU, patients may undergo computed tomography and neurological examination and receive tPA before arriving at the ED.

The authors looked at DTPT for 161 study participants who underwent IAT in 2014-2018, which became the standard of care during the study period.

Median DTPT was 89 minutes for the 94 patients in the MSU group, versus 99 minutes for the 67 patients in the EMS group (P=0.01). After controlling for National Institutes of Health Stroke Status (NIHSS) at baseline, DTPT was 13 minutes shorter with MSU than EMS (P=0.04).

DTPT improved over time for both groups, by 70 minutes for EMS patients and 43 minutes for MSU patients. In 2018, median DTPT was 69 minutes for the MSU group and 94 minutes for the EMS group.

The findings show "room for improvement in both groups across all centers," Dr. Czap and her colleagues write. "Going forward, better utilization of MSU resources and prehospital and postarrival communication between the MSU, ED, stroke and endovascular teams might avoid duplication of effort and allow faster and, in some cases, direct transfer to the endovascular suite."


Stroke 2019.