Mobile Stroke Unit Computed Tomography Angiography Substantially Shortens Door-to-Puncture Time

Area of Science:

• Neurology
• Emergency Medicine
• Medical Imaging

Background:

• Endovascular thrombectomy (ET) is a critical treatment for acute ischemic stroke.
• Door-to-puncture time (DTPT) is a key modifiable metric influencing ET outcomes.
• Computed tomography angiography (CTA) for large vessel occlusion diagnosis is time-consuming.

Purpose of the Study:

• To evaluate if onboard CTA on a Mobile Stroke Unit (MSU) and direct ET team alert shortens DTPT.
• To test the hypothesis that this prehospital strategy reduces DTPT by over 30 minutes.

Main Methods:

• Retrospective comparison of DTPT in patients receiving ET with (Sept 2018-Nov 2019) vs. without (Aug 2014-Aug 2018) onboard MSU CTA.
• Direct alert of the ET team was implemented with the onboard CTA protocol.
• Correlation of DTPT with change in National Institutes of Health Stroke Scale (NIHSS) at 24 hours.

Main Results:

• Median DTPT was significantly shorter by 53.5 minutes with onboard CTA and direct alert (41 min vs. 94.5 min; P<0.001).
• Median on-scene time increased slightly but remained efficient (31.5 min vs. 27 min; P<0.001).
• Shorter DTPT showed a trend towards greater NIHSS improvement (correlation=-0.2, P=0.07).

Conclusions:

• Prehospital management using Mobile Stroke Units with onboard CTA and direct ET team notification substantially reduces DTPT.
• This integrated prehospital approach is effective in accelerating time-critical stroke interventions.
• Further research may explore the impact on long-term neurological outcomes.