Neurological

Cell Interventional Stroke Group Drives Higher Early Outcomes in ELVO Strokes

A Mobile Interventional Stroke Team (MIST) was associated with significantly shorter door-to-recanalization start-up times and improved clinical outcomes compared to a standard drip-and-ship (DS) model, according to study results published in Stroke.

A MIST travels to the hospital where a patient has an Emergent Large Vessel Occlusion (ELVO) stroke for endovascular therapy while the patient is prepared in the angiography suite. In contrast, the DS model transports patients to the nearest hospital to reduce the time to intravenous tissue-type plasminogen activator and then transfer them to a comprehensive stroke center for endovascular therapy. This study, led by a Mount Sinai research team, compared the MIST model to the DS model in terms of time efficiency and improvement in clinical outcomes in patients with a large-vascular occlusion stroke.

A total of 228 patients with 3-month follow-up data were included in this observational study. The study researchers also compared MIST to the mothership model, in which patients are transported directly to the nearest comprehensive stroke center in order to reduce the time to endovascular therapy. The primary endpoint was the duration from the first door to recanalization and final recanalization after successful endovascular therapy.

A total of 20 patients were cared for according to the mothership model, 114 patients according to the DS model, 64 patients according to the MIST model and a further 30 patients according to a combination of DS and MIST (mean age of the total cohort). 68.5 ± 14.0 years; 51.8% women).

The use of MIST was associated with a significantly faster mean initial door-to-recanalization time compared to DS (214.9 ± 85.6 versus 297.9 ± 114.9 minutes; P <0.0001). There was no significant difference between MIST and mother ship in terms of the mean time from door to recanalization (192 versus 179 minutes; P = 0.83).

A significantly larger proportion of patients in the MIST had a full recovery on discharge (National Institutes of Health Stroke Scale of 0 or 1) compared to patients in the DS model (37.9% versus 16.7%; P = 0, 0025).

Compared to DS, the MIST model had a significantly lower mean initial door-to-puncture time (202.5 versus 130.5 minutes; P <0.0001) and EMS contact-to-puncture time Period (232 versus 158 minutes; P <0.0001) associated).

The limitations of this study included the observational design, the inclusion of patients from a largely metropolitan environment, and potential confounders such as the assignment of patient cohorts.

The study researchers concluded that MIST “represents an alternative to the DS model in selected regions and enables time intervals and clinical results similar to the mothership model”.

reference

Morey JR, Oxley TJ, Wei D. et al. Mobile Interventional Stroke Team Model Improves Early Outcomes in Large Vascular Occlusion Stroke: The NYC MIST Study. Stroke. Published online November 2, 2020. doi: 10.1161 / STROKEAHA.120.030248

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