Abstract WMP85: Mobile Stroke Unit: Direct To Angio Or Some Stops Along The Way?

Abstract

Introduction: Reducing the time from last known well to recanalization are associated with better functional outcomes and lower mortality in ischemic stroke. Recent data suggests that a “direct to angio” approach might improve the outcome of stroke patients with suspected emergent large vessel occlusion (ELVO). In this study, we aim to describe our direct-to-angiography vs those taken for additional imaging-first experience in our mobile stroke unit (MSU). Methods: Retrospective chart review from 2014 until 2022 was done. Patients with acute ischemic stroke due to ELVO arriving via MSU to our tertiary care comprehensive stroke center were included. We compared outcomes of those who went directly to the angiography suite versus those who underwent additional imaging studies first. Results: 14 patients with ELVO went directly to angio (DTA group) compared to 52 patients who underwent additional imaging (CTA group). There were no differences in age, gender, pre-morbid vascular risk factors or presenting symptoms. The DTA group had a higher median initial NIHSS and a higher interquartile range when compared to the CTA group but not significant. The DTA group received more thrombolytic therapy compared to the CTA group (p = 0.03). The DTA group had better door-to-groin times (median 39 minutes) compared to the CTA group (median 51.5 minutes) (p = 0.02). TICI 0 - 2a was more frequently seen in the DTA group (35.7%) compared to the CTA group (9.6%) (p = 0.03). Mortality was significantly higher in the DTA group compared to the CTA group (35% vs. 9%; p = 0.028) but there was no difference in functional outcomes amongst groups (mRS 0 - 2 28% vs 17%; p = 0.45). There was a non-significantly higher incidence of tandem occlusions in the DTA group (28.5%) compared to the CTA group (28.5% vs. 15%; p = 0.43). Conclusions: In our analysis, those going direct to angiography from the MSU had less successful recanalization and increased mortality. These findings could also be related to the higher rate of tandem occlusions in the DTA group. Due to head only scanning being available on MSU, additional information from in-hospital scanning may offer other information which may influence selection of patients for the procedure. Further analysis of these paradigms, particularly on MSUs, are warranted.