In a new study from Mount Sinai Health System, researchers found instead of transferring stroke patients to a specialized stroke center, a mobile interventional stroke team (MIST) traveled to the patient to perform emergency stroke surgery resulting in much less disability for patients three months after the stroke.
In this study, the team developed a model called MIST to bring a surgical procedure to the patient.
The MIST team was staffed with a neuro-interventionalist, a fellow in training or a physician assistant, and a radiologic technologist. The team traveled to the location of the patient to perform the treatment procedure.
Medications to dissolve blood clots in large vessels in or leading to the brain are effective in about 15% to 20% of cases. However, most of the patients with a large vessel blockage also require endovascular thrombectomy.
It is a surgical procedure used to remove large blood clots in patients with acute ischemic stroke.
Nearly 90% of strokes are ischemic strokes, which are caused by blood clots in an artery that blocks normal blood flow and oxygen leading to the brain.
Since 2015, endovascular thrombectomy has been the standard of care for stroke therapy and is detailed in the latest 2018 AHA/ASA stroke early management guidelines. Currently, the biggest barrier for stroke patients is timely access to this potentially life-saving procedure.
The team says 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.
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.
Researchers examined data from the New York City MIST trial, focused on 226 stroke patients who received endovascular thrombectomy.
Of those, 106 patients were treated by the MIST team, and 120 were treated using the drip and ship model of care, which requires the patient transfer to a hospital with expertise in endovascular thrombectomy.
The team found for patients treated within six hours of stroke onset, the early window, the rate for a good outcome three months after the event was much 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 much better among the MIST patients than the transferred patients.
This study stresses the importance of ‘time is brain,’ especially for patients in the early time window.
The findings highlight the potential benefit of early and urgent treatment for patients with large vessel stroke. Stroke systems of care need to take advantage of any opportunity to treat patients early, wherever they are.
If you care about stroke, please read studies about preventing a stroke by knowing your risks and findings of heavy alcohol drinking could cause stroke, dangerous artery disease.
For more information about stroke and your health, please see recent studies about feeling dizzy when standing up may signal high dementia and stroke risks and results showing that prescribed drugs with this feature linked to memory loss, stroke.
The study is published in Stroke. One author of the study is Johanna T. Fifi, M.D.
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