Evaluate the impact of a direct-to-angiosuite (DTAS) workflow on Mobile Stroke Units (MSU) in stroke patients with large vessel occlusions (LVO) needing mechanical thrombectomy (MT).

MSUs are equipped with CT/CT angiography (CTA), thrombolytics and personnel that can deliver emergency stroke care to patients and reduce time-to-thrombolytic administration and improve clinical outcomes. Although there is no benefit of MSUs on alert-to-puncture times, a reduction in time was seen when CTA was obtained on-board the MSU, which suggests that a DTAS protocol may be a powerful method to reduce delay from alert-to-puncture.

The MSU DTAS group will be comprised of suspected LVO patients having CTA on-board the MSU, alerting of the MT team en route, and bypassing the Emergency Department (ED) with direct transport to the angiosuite. The control group will comprise of the standard Emergency Medical Services (EMS) management group from the BEST-MSU study.  In those patients, CTA was done after arrival to the ED and then transported to the angiosuite.  Primary outcome will be alert-to-puncture time. Secondary outcomes will include 90-day modified Rankin scale and degree of recanalization. Analysis of the mRS will be a propensity-score based ordinal logistic regression adjusted for baseline predictors to estimate the common odds ratio. Based on pilot data, we estimate we will detect at least a 30-minute reduction in alert-to-puncture time.

In a preliminary analysis of the BEST-MSU study, DTAS management resulted in shorter alert-to-puncture (42 minutes) and door-to-puncture times (50 minutes) with similar safety and clinical outcomes compared with standard management. We plan to enroll additional patients to the MSU DTAS pathway and a more detailed and final analysis will be available upon abstract presentation at the AAN conference.

A DTAS workflow, triggered by CTA on MSU patients suspected of having LVO, substantially speeds alert-to thrombectomy, and may improve recanalization and clinical outcome.