Understanding Nuances of Mobile Stroke Units and When to Transfer Directly to Angiography: Shazam Hussain, MD, FRCP, FAHA

WATCH TIME: 3 minutes

"Maybe it was more about identifying those patients, getting to thrombolysis, getting them to a center, and then getting the additionally necessary workup that you need to optimize that situation."

Mobile stroke units (MSUs) offer several advantages, including ready medical expertise and imaging technology that evaluates patients with suspected stroke rapidly and accurately. The most important benefit this approach brings is the quick diagnosis of the stroke type, allowing hemorrhage to be ruled out and treatment with tissue plasminogen activator to be started quickly if appropriate. As more MSUs continue to be developed across the world, a group of investigators aimed to see whether taking patients with suspected large vessel occlusion (ELVO) directly to angiography suite or for additional imaging studies first was more beneficial.

The trial, led by Shazam Hussain, MD, FRCP, FANA, collected retrospective data on 14 patients who went directly to angio (DTA group) vs 52 patients who underwent additionally imaging (CTA group). Between the 2 groups, there were no initial differences in age, gender, or pre-morbid vascular risk factors, except the DTA group had a higher median National Institutes of Health Stroke Scale score and higher interquartile range.

Presented at the 2023 International Stroke Conference (ISC), held February 8-10, in Dallas, Texas, the findings showed that mortality was significantly higher in the DTA group compared with CTA (35% vs 9%; P = .028), but there was no difference in functional outcomes amongst groups (modified Rankin Scale score 0-2: 28% vs 17%; P = .45). Hussain, director of Cleveland Clinic’s Cerebrovascular Center, sat down with NeurologyLive® following his presentation to discuss the reasons for this type of study, and the take-home points the clinical community should be aware of. He also provided perspective on the higher incidence of tandem occlusions observed in the DTA group, which he claims may have impacted the findings.

Click here for more coverage of ISC 2023.

REFERENCES
1. Martucci M, Toth G, Buletko A, Khawaja Z, Russman AN, Hussain MS. Mobile stroke unit: direct to angio or some stops along the way? Presented at: 2023 International Stroke Conference; February 8-10; Dallas, TX. Abstract WMP85