Compare outcomes of mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) presenting to a single primary stroke center (PSC), when performed either by a mobile interventional stroke team (MIST) on site or after interhospital transfer to a comprehensive stroke center (CSC).

MT has become standard of care in acute LVO. Most hospitals cannot perform MT on site, requiring patient transfer to a CSC. Within a metropolitan multihospital healthcare system, utilization of a MIST shortens time to intervention, potentially resulting in better outcomes and decreased cost of care.  

We selected patients with acute LVO presenting to a PSC in Manhattan, NY, from 09/2013 to 02/2018, who underwent MT on site or after transfer to a CSC. Outcomes were assessed by Thrombolysis in Cerebral Infarction (TICI), NIH Stroke Scale (NIHSS), and modified Rankin Scale (mRS) scores.

One endovascular team performed 48 MTs; 37 patients were selected for analysis. 28 MTs were performed on site (group 1) and 9 after transfer (group 2). Median age was 74.5 and 73 years respectively. In group 1, median NIHSS and Alberta Stroke Program Early CT Score (ASPECTS) on presentation were 18 and 9, compared to 17 and 10 in group 2. Median door-to-puncture (DTP) time was 144.5 and 233 minutes respectively (p<0.05). In group 1, 82% had baseline mRS 0-2, compared to 36% at 90 days. In group 2, 100% had baseline mRS 0-2, and 22% at 90 days. TICI ≥2B was achieved in 89% in both groups, with complete reperfusion (TICI 3) in 50% and 11% respectively.

DTP times were significantly shorter in patients treated by a MIST. This group also had higher reperfusion grades and rates of functional independence, although statistical significance was not reached. Our data indicates that utilization of a MIST may be associated with better outcomes in acute LVO.