Department of Neurology and Neurosurgery, McGovern Medical School, University of Texas Health Science Center-Houston, Houston, Texas.
Mobile Stroke Unit and Stroke Research, Clinical Innovation and Research Institute, Memorial Hermann Hospital - Texas Medical Center, Houston, Texas.
Semin Neurol. 2021 Feb;41(1):9-15. doi: 10.1055/s-0040-1722724. Epub 2021 Jan 28.
Ischemic stroke is a leading cause of death and major disability that impacts societies across the world. Earlier thrombolysis of blocked arteries with intravenous tissue plasminogen activator (tPA) and/or endovascular clot extraction is associated with better clinical outcomes. Mobile stroke units (MSU) can deliver faster tPA treatment and rapidly transport stroke patients to centers with endovascular capabilities. Initial MSU trials in Germany indicated more rapid tPA treatment times using MSUs compared with standard emergency room treatment, a higher proportion of patients treated within 60 minutes of stroke onset, and a trend toward better 3-month clinical outcomes with MSU care. In the United States, the first multicenter, randomized clinical trial comparing standard versus MSU treatment began in 2014 in Houston, TX, and has demonstrated feasibility and safety of MSU operations, reliability of telemedicine technology to assess patients for tPA eligibility without additional time delays, and faster door-to-groin puncture times of MSU patients needing endovascular thrombectomy in interim analysis. Scheduled for completion in 2021, this trial will determine the cost-effectiveness and benefit of MSU treatment on clinical outcomes compared with standard ambulance and hospital treatment. Beyond ischemic stroke, MSUs have additional clinical and research applications that can profoundly impact other cohorts of patients who require time-sensitive neurological care.
缺血性脑卒中是全球范围内导致死亡和残疾的主要原因。早期经静脉给予组织型纤溶酶原激活剂（tPA）和/或血管内取栓治疗阻塞的动脉与更好的临床转归相关。移动卒中单元（MSU）可以更快地给予 tPA 治疗，并迅速将卒中患者转运至具有血管内治疗能力的中心。德国的早期 MSU 试验表明，与标准急诊室治疗相比，MSU 可更快地进行 tPA 治疗，在卒中发作后 60 分钟内接受治疗的患者比例更高，且 MSU 治疗的 3 个月临床转归有改善趋势。在美国，2014 年在德克萨斯州休斯顿启动了一项比较标准治疗与 MSU 治疗的多中心、随机临床试验，该试验证明了 MSU 操作的可行性和安全性、远程医疗技术评估 tPA 适应证的可靠性，且无需额外的时间延迟，MSU 患者的门到股动脉穿刺时间更快，在中期分析中需要血管内取栓的患者。该试验计划于 2021 年完成，将确定与标准救护车和医院治疗相比，MSU 治疗在临床转归方面的成本效益和获益。除缺血性脑卒中外，MSU 还有其他临床和研究应用，可能会对需要及时进行神经科治疗的其他患者群体产生深远影响。
