Mobile Interventional Stroke Team Model Improves Early Outcomes in Large Vessel Occlusion Stroke: The NYC MIST Trial
Jacob R Morey, Thomas J Oxley, Daniel Wei, Christopher P Kellner, Neha S Dangayach, Laura Stein, Danny Hom, Danielle Wheelwright, Liorah Rubenstein, Maryna Skliut, Hazem Shoirah, Reade A De Leacy, I Paul Singh, Xiangnan Zhang, Steven Persaud, Stanley Tuhrim, Mandip Dhamoon, Joshua Bederson, J Mocco, Johanna T Fifi, Mount Sinai Stroke Investigators*, Irene R Boniece, Carolyn D Brockington, Michael Fara, Qing Hao, Deborah R Horowitz, Cappi Lay, John Liang, E John Nasrallah, Tara Roche, Kara F Sheinart, Inder Paul Singh, Christopher Tegtmeyer, Jesse Weinberger, Jacob R Morey, Thomas J Oxley, Daniel Wei, Christopher P Kellner, Neha S Dangayach, Laura Stein, Danny Hom, Danielle Wheelwright, Liorah Rubenstein, Maryna Skliut, Hazem Shoirah, Reade A De Leacy, I Paul Singh, Xiangnan Zhang, Steven Persaud, Stanley Tuhrim, Mandip Dhamoon, Joshua Bederson, J Mocco, Johanna T Fifi, Mount Sinai Stroke Investigators*, Irene R Boniece, Carolyn D Brockington, Michael Fara, Qing Hao, Deborah R Horowitz, Cappi Lay, John Liang, E John Nasrallah, Tara Roche, Kara F Sheinart, Inder Paul Singh, Christopher Tegtmeyer, Jesse Weinberger
Abstract
Background and purpose: Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center (TSC) to perform endovascular therapy. Our aim is to determine whether the MIST model is more time-efficient and leads to improved clinical outcomes compared with standard drip-and-ship (DS) and mothership models.
Methods: This is a prospective observational cohort study with 3-month follow-up between June 2016 and December 2018 at a multicenter health system, consisting of one comprehensive stroke center, 4 TSCs, and several primary stroke centers. A total of 228 of 373 patients received endovascular therapy via 1 of 4 models: mothership with patient presentation to a comprehensive stroke center, DS with patient transfer from primary stroke center or TSC to comprehensive stroke center, MIST with patient presentation to TSC and MIST transfer, or a combination of DS with patient transfer from primary stroke center to TSC and MIST. The prespecified primary end point was initial door-to-recanalization time and secondary end points measured additional time intervals and clinical outcomes at discharge and 3 months.
Results: MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes (P<0.01). MIST and mothership had similar median door-to-recanalization times of 192 minutes and 179 minutes, respectively (P=0.83). A greater proportion had a complete recovery (National Institutes of Health Stroke Scale of 0 or 1) at discharge in MIST compared with DS (37.9% versus 16.7%; P<0.01). MIST had 52.8% of patients with modified Rankin Scale of ≤2 at 3 months compared with 38.9% in DS (P=0.10).
Conclusions: MIST led to significantly faster initial door-to-recanalization times compared with DS, which was comparable to mothership. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03048292.
Keywords: ischemic stroke; patient transfer; thrombectomy.
Source: PubMed