Mobile Stroke Unit and Mechanical Thrombectomy Workflow: A Single Center 5-Year Experience

Mobile stroke unit (MSU) has been demonstrated to significantly reduce time to treatment and increase the chances of early intravenous thrombolysis with positive effect on clinical outcomes. The evidence of its impact on the treatment time metrics and outcomes in endovascular treatment-eligible patients outside of large clinical trials is limited. We sought to investigate the potential workflow benefits of MSU-based care compared with emergency medical services-based care for endovascular treatment-eligible patients.

This is an observational, cross-sectional study, based on a retrospective review of a single-center, prospectively maintained, mechanical thrombectomy database spanning June 2018 to November 2023. Patients receiving endovascular treatment for large-vessel occlusion strokes were divided in 2 groups: MSU-transported and emergency medical services-transported (mothership) presenting within MSU operating days/hours. Treatment time metrics and clinical outcomes were compared.

A total of 565 patients who fit inclusion criteria were identified: 66 were transported via MSU and 499 were transported via emergency medical services. MSU-transported patients were more likely to be within treatment window for intravenous thrombolysis and to bypass multimodal imaging. The co-primary end points (door to angio, door to puncture, and door to reperfusion times) favored the MSU-transported patients (41 versus 62 minutes, 58 versus 82 minutes, 96 versus 127 minutes; P<0.001). The times from last known well to puncture were significantly shorter in the MSU-transported group (237 versus 389 minutes, P = 0.021). Functional outcomes at 90 days and rates of intracerebral hemorrhage were similar between the 2 groups.

In this single-center analysis, MSU-transported patients demonstrated improved time metrics, with shorter treatment times when compared with emergency medical services-transported patients. Outcomes and safety parameters did not differ between the 2 groups.