Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.).
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.).
Stroke. 2020 Dec;51(12):3495-3503. doi: 10.1161/STROKEAHA.120.030248. Epub 2020 Nov 2.
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.
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.
MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes (<0.01). MIST and mothership had similar median door-to-recanalization times of 192 minutes and 179 minutes, respectively (=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%; <0.01). MIST had 52.8% of patients with modified Rankin Scale of ≤2 at 3 months compared with 38.9% in DS (=0.10).
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.
将紧急大血管闭塞性卒中患者分诊至初级卒中中心，然后转至综合卒中中心，这会导致血管内治疗的时间延长。移动介入卒中团队（MIST）通过将 MIST 转移到血栓切除能力卒中中心（TSC）来进行血管内治疗，提供了一种替代模式。我们的目的是确定与标准滴注和转运（DS）以及母舰模型相比，MIST 模型是否更节省时间，并导致更好的临床结果。
这是一项前瞻性观察队列研究，在 2016 年 6 月至 2018 年 12 月期间在一个多中心医疗系统中进行，该系统由一个综合卒中中心、4 个 TSCs 和几个初级卒中中心组成。共有 228 名 373 名患者接受了以下 4 种模型中的 1 种进行血管内治疗：母舰，患者就诊于综合卒中中心；DS，患者从初级卒中中心或 TSC 转至综合卒中中心；MIST，患者就诊于 TSC 并转移 MIST；或 DS 与患者从初级卒中中心转至 TSC 以及 MIST 的组合。主要终点是初始门到再通时间，次要终点测量额外的时间间隔和出院时及 3 个月时的临床结果。
与 DS 相比，MIST 的平均初始门到再通时间快 83 分钟（<0.01）。MIST 和母舰的中位门到再通时间分别为 192 分钟和 179 分钟（=0.83）。与 DS 相比，MIST 出院时完全恢复（国立卫生研究院卒中量表 0 或 1）的比例更高（37.9%比 16.7%；<0.01）。与 DS 相比，MIST 在 3 个月时改良 Rankin 量表评分≤2 的患者比例为 52.8%，DS 为 38.9%（=0.10）。
与 DS 相比，MIST 显著缩短了初始门到再通时间，与母舰相当。时间的缩短转化为改善了短期结果，并改善了长期结果的趋势。登记：网址：https://www.clinicaltrials.gov。唯一标识符：NCT03048292。
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