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Patients transported by a mobile stroke unit have more favorable time metrics, but have similar outcomes as those transported by emergency medical services (EMS). These findings were published in Stroke: Vascular and Interventional Neurology.
Investigators from Grady Memorial Hospital in the United States hypothesized that patients transported by mobile stroke unit after large vessel occlusion (LVO)-related ischemic stroke (IS) would have faster time metrics when receiving mechanical thrombectomy than patients transported by EMS.
This study was a cross-sectional retrospective review of prospectively collected data between 2018 and 2023. Patients (N=565) who received endovascular therapy for LVO-related IS were evaluated for the endpoints of time interval between door-to-imaging, door-to-puncture, and door-to-reperfusion on the basis of whether they arrived at the hospital by mobile stroke unit (n=66) or EMS (n=499).
The mobile stroke unit and EMS cohorts comprised 55% and 56% men, they had median ages of 66 (IQR, 47-77) and 66 (IQR, 56-76) years, they had an Alberta Stroke Program Early Computed Tomography (ASPECTS) score of 9 (IQR, 8-10) and 8 (IQR, 7-10), and the most common occlusion locations were middle cerebral artery M1 (39% vs 42%) or M2 (38% vs 23%), respectively.
Patients who arrived by mobile stroke unit had shorter door-to-imaging (median, 9 vs 17 min; P <.001), -puncture (median, 58 vs 82 min; P <.001), and -reperfusion (median, 96 vs 127 min; P <.001) than patients who arrived by EMS.
In the linear regression analysis, door-to-puncture was significantly shorter with mobile stroke unit than with EMS (b, -23.3; 95% CI, -34.7 to -11.9; P <.001).
The significant shortening of time from door-to-puncture with mobile stroke unit was significantly mediated by multimodal imaging (8%; P =.012), time to multimodal imaging completion (53%; P <.001), and time to any imaging completion (48%; P <.001). Direct-to-angio was not a significant mediator (P =.132).
The mobile stroke unit- and EMS-transported patients did not differ by modified Rankin Scale (mRS) score at discharge (median, 3 vs 3; P =.198), mRS score at 90 days (median, 3 vs 3; P =.455), or mortality at 90 days (23% vs 20%; P =.691).
This study was not powered to detect significant differences in clinical outcomes.
The study authors concluded, “MSU [mobile stroke unit] transport was associated with improved workflow leading to shorter times to treatment. Safety and clinical outcomes were comparable among MSU and EMS-transport groups, supporting the need for further investigation of the direct-to-angio approach for patients with LVO.”
This article originally appeared on The Cardiology Advisor
