Researchers compared 90-day functional outcomes between patients treated by MIST and those transferred to a stroke center for endovascular thrombectomy. Using the modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale to assess outcomes, they analyzed results of patients who were seen within six hours of stroke-symptom onset (early therapeutic window) and after six hours of stroke symptoms (late window).

Key findings were:


For patients treated within six hours of stroke onset, the early window, the rate for a good outcome (mRS less than or equal to 2 - mobile and can perform daily tasks) three months after the event was significantly higher in patients from the MIST group (54%), compared to the patients in the transferred group (28%).
Among patients treated during the early window, functional outcomes at discharge were significantly better among the MIST patients than the transferred patients.
For patients treated in the late window, however, outcomes were similar: 35% of patients in the MIST group had a good 90-day outcome, compared to 41% in the transferred group.
“Ischemic strokes often progress rapidly and can cause severe damage because brain tissue dies quickly without oxygen, resulting in serious long-term disabilities or death,“ Fifi said. ”Assessing and treating stroke patients in the early window means that a greater number of fast-progressing strokes are identified and treated.”

However, the study’s findings are limited because it was not a randomized study. Data for the NYC MIST trial was collected prospectively, however, this analysis was done retrospectively. “The MIST approach to care continues as more institutions and cities have implemented the model,” Fifi said.

“This study stresses the importance of ‘time is brain,’ especially for patients in the early time window. Although the study is limited by the observational, retrospective design and was performed at a single integrated center, the findings are provocative,” said Louise McCullough, M.D., AHA/ASA chair of the International Stroke Conference and chair of the department of neurology at McGovern Medical School at The University of Texas Health Science Center at Houston; chief of neurology service at Memorial Hermann Hospital – Texas Medical Center, Houston, Texas. “The use of a MIST model highlights the potential benefit of early and urgent treatment for patients with large vessel stroke. Stroke systems of care need to take advantage of any opportunity to treat patients early, wherever they are.”

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