DALLAS, Aug. 5, 2021 — In a pilot program in New York City, instead of transferring stroke patients to a specialized stroke center, a mobile interventional stroke team (MIST) traveled to the patient to perform emergency stroke surgery resulting in significantly less disability for patients three months after the stroke, compared to patients who lost valuable time in the transfer to a higher level stroke center, according to new research published today in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

In this study, stroke specialists at Mount Sinai Health System in New York City developed a model called MIST to bring a surgical procedure known as endovascular thrombectomy to the patient. The MIST team was staffed with a neuro-interventionalist, a fellow in training or a physician assistant, and a radiologic technologist. The team traveled to the location of the patient to perform the endovascular thrombectomy procedure.

Medications to dissolve blood clots in large vessels in or leading to the brain are effective in about 15 percent to 20 percent of cases. However, most of the patients with a large vessel blockage also require endovascular thrombectomy. Endovascular thrombectomy is a surgical procedure used to remove large blood clots in patients with acute ischemic stroke. Nearly 90% of strokes are ischemic strokes, which are caused by blood clots in an artery that blocks normal blood flow and oxygen leading to the brain. Since 2015, endovascular thrombectomy has been the standard of care for stroke therapy and is detailed in the latest 2018 AHA/ASA stroke early management guidelines. Currently, the biggest barrier for stroke patients is timely access to this potentially life-saving procedure.
“Less than 50% of Americans have direct access to endovascular thrombectomy, the others must be transferred to a thrombectomy-capable hospital for treatment, often losing over two hours of time to treatment,” said study co-author Johanna T. Fifi, M.D., associate professor of neurosurgery, neurology and radiology in the department of neurosurgery at the Icahn School of Medicine at Mount Sinai in New York City. “Every minute is precious in treating stroke, and getting to a center that offers thrombectomy is very important. The MIST model would address this by providing faster access to this potentially life-saving, disability-reducing procedure.”

Researchers examined data from the New York City MIST trial, focused on 226 stroke patients who received endovascular thrombectomy from January 2017 to February 2020 at four hospitals within the Mount Sinai Health System (one is a certified comprehensive stroke center and three are thrombectomy-capable stroke centers). Of those, 106 patients were treated by the MIST team, and 120 were treated using the drip and ship model of care, which requires the patient transfer to a hospital with expertise in endovascular thrombectomy. Current standards are to treat patients with medications to dissolve the clot and then transfer the patient to a hospital with the expertise to perform endovascular thrombectomy. All patients in the analysis were functionally independent before having a stroke.

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