High-resolution CT with arch/neck/head CT angiography on a mobile stroke unit

Area of Science:

• Neurology
• Emergency Medicine
• Radiology

Background:

• Mobile stroke units (MSUs) are emerging as a critical tool in acute stroke care.
• The diagnostic performance and dependability of advanced imaging, specifically 16-slice CT with CT angiography (CTA), within MSUs have not been previously established.

Purpose of the Study:

• To evaluate the performance dependability and diagnostic yield of a novel mobile stroke unit (MSU).
• To assess the utility of 16-slice CT with multiphasic CT angiography (CTA) for diagnosing stroke and identifying large vessel occlusions (LVOs) in the prehospital setting.

Main Methods:

• A prospective observational study was conducted using a mobile stroke unit (MSU) equipped with high-resolution, 16-slice CT and multiphasic CTA.
• Field CT/CTA was performed on all suspected stroke patients, with data collected over 365 days to quantify performance, efficiency, and diagnostic yield.

Main Results:

• The MSU responded to 1031 activations, transporting 402 patients with confirmed strokes or other neurological emergencies.
• Advanced imaging identified large vessel occlusions in 30% of ischemic stroke patients, enabling timely thrombectomy in 41% of these cases.
• The total time from CT/CTA start to image availability was 4.0 minutes, and no imaging required re-acquisition due to quality issues, facilitating correct patient triage and direct bypass of the emergency department.

Conclusions:

• The use of mobile stroke units (MSUs) with advanced imaging, including multiphasic head and neck CTA, is feasible and effective.
• This technology provides a high yield for detecting large vessel occlusions (LVOs).
• MSU implementation allows for direct patient management and bypass of the emergency department, improving efficiency in acute stroke care.