The director of Cleveland Clinic’s Cerebrovascular Center discussed the decisions mobile stroke units face and why opting for direct transfer to angiography is meant for certain scenarios. [WATCH TIME: 3 minutes]
WATCH TIME: 3 minutes
"We’re getting into the nuances of what exactly these workflows look like. For example, in this particular study, we’re trying to answer: is it about getting there as fast as possible or are there some additional steps that we need to decide about how to optimize the patient’s care?"
Over the past decade, there has been significant expansion in mobile stroke units (MSUs), specialized ambulances equipped with the personnel, equipment, and imaging capability to diagnose and treat acute stroke in the prehospital setting. There have been several notable studies such as B_PROUD (NCT03931616) and BEST-MSU (NCT02190500), which have shown that compared with conventional emergency care, treatment aboard MSUs as safe and led to improved functional outcomes in patients with stroke. As MSUs become more widely implemented, clinicians continue to learn the nuances to care, and which patients may seek the greatest outcomes.
At the 2023 International Stroke Conference (ISC), held February 8-10, in Dallas, Texas, a group of investigators, led by Shazam Hussain, MD, FRCP, FAHA, aimed to describe whether direct transfer to angiography suite is more beneficial than additional imaging-first experiences for those with suspected emergent large vessel occlusion. While the literature has shown that reducing time from last known well to recanalization is associated with better functional outcomes and lower mortality in ischemic stroke, findings from Hussain et al’s study showed less successful recanalization and increased mortality for those directly going to angiography from the MSU.
The investigators noted that because only head scanning was available on MSU, additional information from in-hospital scanning may offer other information which may influence selection of patients for the procedure. In an interview with NeurologyLive®, Hussain, director of Cleveland Clinic’s Cerebrovascular Center, provided perspective on the pros and cons to directly transferring to angiography, and the research being conducted in the field. Additionally, he discussed some of the notable data points from the study, including how this adds another layer of treatment optimization.
Click here for more coverage of ISC 2023.