Mobile interventional stroke teams lead to faster treatment times for thrombectomy in large vessel occlusion

Daniel Wei, Thomas J. Oxley, Dominic A. Nistal, Justin R Mascitelli, Natalie Wilson, Laura Stein, John Liang, Lena M. Turkheimer, Jacob R. Morey, Claire Schwegel, Ahmed J. Awad, Hazem Shoirah, Christopher P. Kellner, Reade A. De Leacy, Stephan A. Mayer, Stanley Tuhrim, Srinivasan Paramasivam, J. Mocco, Johanna T. Fifi

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Background and Purpose-Endovascular recanalization treatment for acute ischemic stroke is a complex, time-sensitive intervention. Trip-and-treat is an interhospital service delivery model that has not previously been evaluated in the literature and consists of a shared mobile interventional stroke team that travels to primary stroke centers to provide on-site interventional capability. We compared treatment times between the trip-and-treat model and the traditional drip-and-ship model. Methods-We performed a retrospective analysis on 86 consecutive eligible patients with acute ischemic stroke secondary to large vessel occlusion who received endovascular treatment at 4 hospitals in Manhattan. Patients were divided into 2 cohorts: Trip-and-treat (n=39) and drip-and-ship (n=47). The primary outcome was initial door-to-puncture time, defined as the time between arrival at any hospital and arterial puncture. We also recorded and analyzed the times of last known well, IV-tPA (intravenous tissue-type plasminogen activator) administration, transfer, and reperfusion. Results-Mean initial door-to-puncture time was 143 minutes for trip-and-treat and 222 minutes for drip-and-ship (P<0.0001). Although there was a trend in longer puncture-to-recanalization times for trip-and-treat (P=0.0887), initial door-to-recanalization was nonetheless 79 minutes faster for trip-and-treat (P<0.0001). There was a trend in improved admission-to-discharge change in National Institutes of Health Stroke Scale for trip-and-treat compared with drip-andship (P=0.0704). Conclusions-Compared with drip-and-ship, the trip-and-treat model demonstrated shorter treatment times for endovascular therapy in our series. The trip-and-treat model offers a valid alternative to current interhospital stroke transfers in urban environments.

Original languageEnglish (US)
Pages (from-to)3295-3300
Number of pages6
JournalStroke
Volume48
Issue number12
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Keywords

  • Endovascular
  • Puncture
  • Reperfusion
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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    Wei, D., Oxley, T. J., Nistal, D. A., Mascitelli, J. R., Wilson, N., Stein, L., Liang, J., Turkheimer, L. M., Morey, J. R., Schwegel, C., Awad, A. J., Shoirah, H., Kellner, C. P., De Leacy, R. A., Mayer, S. A., Tuhrim, S., Paramasivam, S., Mocco, J., & Fifi, J. T. (2017). Mobile interventional stroke teams lead to faster treatment times for thrombectomy in large vessel occlusion. Stroke, 48(12), 3295-3300. https://doi.org/10.1161/STROKEAHA.117.018149