Direct to Angiosuite in Acute Stroke with Mobile Stroke Unit

Area of Science:

• Neurology
• Emergency Medicine
• Vascular Surgery

Background:

• Early reperfusion is critical for favorable outcomes in acute ischemic stroke (AIS) with large vessel occlusion (LVO).
• Mobile stroke units (MSU) offer pre-hospital evaluation and direct transfer capabilities.
• This study examines the use of MSU for direct-to-angiosuite (DTAS) transfers in suspected LVO cases.

Purpose of the Study:

• To evaluate the effectiveness of MSU-facilitated DTAS transfers for AIS patients with suspected LVO.
• To compare workflow times between DTAS and conventional angiosuite transfers.
• To identify patient characteristics associated with successful DTAS utilization.

Main Methods:

• Retrospective review of prospectively collected data from November 2019 to August 2022.
• Analysis of patients evaluated and transferred by the University of Alberta Hospital MSU.
• Comparison of outcomes and workflow metrics between DTAS and non-DTAS groups.

Main Results:

• Nine patients underwent DTAS, while 32 were transferred conventionally (no-DTAS).
• DTAS patients had higher stroke severity (NIHSS 22 vs. 14.5, p=0.001) and more frequent hyperdense vessels on pre-hospital CT (88.88% vs. 34.35%, p=0.003).
• DTAS significantly reduced door-to-artery puncture time (31 vs. 79 min) and door-to-recanalization time (69 vs. 105.5 min, p<0.001).

Conclusions:

• MSU-facilitated DTAS is an effective strategy for reducing endovascular thrombectomy (EVT) workflow times in selected AIS patients.
• This approach is particularly beneficial for patients with high NIHSS scores, cortical signs, and evidence of hyperdense vessels.
• DTAS streamlines treatment, improving efficiency for acute stroke intervention.