Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital
Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.
SOURCE: Tsivgoulis G, Geisler F, Katsanos AH, et al. Ultraearly intravenous thrombolysis for acute ischemic stroke in mobile stroke unit and hospital settings. A comparative analysis. Stroke 2018;49:1996-1999.
Time from onset of acute ischemic stroke until treatment with intravenous thrombolysis is the critical factor that determines the likelihood of both successful reperfusion as well as long-term functional outcome. However, only a small fraction of patients with acute ischemic stroke receive intravenous thrombolysis treatment within the first 60 minutes from symptom onset, also known as the “golden” hour when this treatment is presumed to have the greatest benefit. The advancement of mobile stroke treatment units (MSU), first in Europe and then in North America, has resulted in a dramatic increase in the number of patients treated within the first 60 minutes, but whether this results in equivalent outcome compared to hospital care is unknown.
The investigators in Berlin, with a long history of mobile stroke treatment unit experience, identified and compared a cohort of MSU-treated patients with those treated in the hospital. They identified 117 MSU patients treated within the first 60 minutes (38.4% of 305 MSU treated patients) and compared them with 136 hospital-setting patients treated within 60 minutes (0.9% of 15,591 hospital-treated patients). They evaluated outcomes at 90 days. They found no significant differences between the groups, with favorable functional outcome in 51.3% of MSU-treated patients vs. 46.2% of hospital-treated patients, with mortality in 7.7% of MSU patients vs. 9.9% of hospital-treated patients. At three months, there was no difference in the distribution of the modified Rankin scale scores between the two groups.
Tsivgoulis et al concluded that the safety and efficacy of ultraearly intravenous thrombolysis for patients with acute ischemic stroke is the same whether used on an MSU or in the hospital setting. However, it is 40 times more likely that an MSU-treated patient will be treated within the first 60 minutes compared to a hospital-setting patient.