Abstract
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.
Keywords
acute stroke - thrombectomy - thrombolysis - prehospital - emergency neurology
