On-site stroke therapy tied to better clinical outcomes
Stroke patients achieve better 90-day outcomes when treated on site by a mobile stroke team instead of being transported to a specialized facility, according to new data published in Stroke.
As part of a pilot program at Mount Sinai Health System in New York City, a mobile interventional stroke team (MIST) traveled directly to a 106 stroke patients to perform an endovascular thrombectomy. Another 120 patients were treated using the standard "drip and ship" model of care, with the procedure being performed at a high-level stroke center. All patients were treated from January 2017 to February 2020.
Reviewing 90-day outcomes, the authors found that treatment by the mobile stroke team saved valuable time and resulted in lower disability rates.
“Ischemic strokes often progress rapidly and can cause severe damage because brain tissue dies quickly without oxygen, resulting in serious long-term disabilities or death,“ study co-author 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 prepared statement. ”Assessing and treating stroke patients in the early window means that a greater number of fast-progressing strokes are identified and treated.”
Among the key findings in the MIST study:
- For patients treated within six hours of stroke onset, the early window, the rate for a good outcome three months after the event was significantly higher in patients from the MIST group (54%), compared to the patients in the transferred group (28%).
- Among patients treated during the early window, functional outcomes at discharge were significantly better among the MIST patients than the transferred patients.
- For patients treated in the late window, however, outcomes were similar: 35% of patients in the MIST group had a good 90-day outcome, compared to 41% in the transferred group.
According to the authors, one of the biggest obstacles in the treatment of stroke is quick access to an endovascular thrombectomy.
“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 two hours of time to treatment,” Fifi said. “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 life-saving, disability-reducing procedure.”
Read the full analysis here.