The analysis included data from 226 stroke patients with large vessel occlusion stroke, of whom 106 were treated by the mobile intervention stroke team (MIST) and 120 were referred to a comprehensive stroke center from another medical center. It found that when patients were treated less than 6 hours after stroke onset, 54% treated by the mobile team had a good functional outcome at 90 days, compared with 28% among those treated with the "drip and ship" (DS) model, according to the report published in Stroke.
"The take-home message is that using one team that covers multiple hospitals in a certain geographic area and travels to the patient can speed up times to large vessel stroke treatment with thrombectomy has now been shown to improve outcomes over transferring patients," said study coauthor Dr. Johanna Fifi, an associate director of the Cerebrovascular Center and site director of cerebrovascular services at Mount Sinai West in New York City. "The implementation of MIST has to be done thoughtfully and will vary in different health care systems and cities, but it is another tool that complements EMS triage and mobile stroke units."
Time to treatment is crucial, Dr. Fifi said.
"When looking at data from thrombectomy for large vessel stroke, it is clear that you want to be taken to a place that offers thrombectomy the first time and not require being transferred from one hospital to the next," Dr. Fifi said in an email. "Systems of care for stroke are regional and we have to advocate at that level for laws and regulations to allow efficiency of treatment using all of these tools including MISTs."
To assess the value of mobile treatment teams - which include a neuro-interventionist, an assistant, and a radiologic technologist - Dr. Fifi and her colleagues analyzed data from the NYC MIST Trial and from a prospective stroke quality assurance database on patients who received endovascular thrombectomy (EVT) between January 2017 and February 2020.
Among 561 EVT cases, 226 patients were included in the MIST (n=106) and DS (n=120) cohorts. The researchers excluded 335 patients who either were already in hospital at the time of stroke or presented to the CSC where a team did not have to travel to treat them or were not independent at baseline.
Most patients (77.4% MIST and 74.2% DS) were treated in the early window (last known well of ≤6 hours). MIST had significantly faster initial door-to-final recanalization times and DS had more patients with chronic medical conditions and a different occlusion location distribution - that is, proportion of middle cerebral artery occlusions versus other sites - the study team notes.
The study's primary endpoint, the proportion of patients with a good outcome (modified Rankin Scale score of 0-2) at 90 days, was significantly greater in the MIST cohort than in the DS cohort, in the early time window (54.1% versus 27.9%), but not in the late window (35.0% versus 27.9%).
"The Mobile Interventional Stroke Team (MIST) model is a useful alternative to drip-and-ship models, particularly in densely populated urban environments with transportation barriers to delivering more conventional stroke systems of care," said Dr. Sandra Narayanan, an associate professor in the departments of neurology and neurological surgery at the University of Pittsburgh School of Medicine.
"When appropriately resourced, the MIST model can save significant time and improve 90-day neurological outcomes in acute ischemic stroke patients presenting in early time windows," Dr. Narayanan, who was not involved in the new study, said in an email.
SOURCE: https://bit.ly/3fGmgNb Stroke, online August 5, 2021.
By Linda Carroll
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