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O-010 mobile stroke treatment unit and golden hour of thrombolysis for emergent large vessel occlusion: initial experience
  1. R Cerejo,
  2. A Taqui,
  3. A Itrat,
  4. S John,
  5. K Uchino,
  6. G Toth,
  7. P Rasmussen,
  8. M Hussain
  1. Cleveland Clinic Foundation, Cleveland OH, Cleveland, OH, USA

Abstract

Introduction “Golden hour” of thrombolysis, defined as initiation of intravenous tissue plasminogen activator (IV tPA) within 60 min of stroke symptom onset, has shown beneficial outcomes with recovery and favorable discharges. The mobile stroke treatment unit (MSTU) has shown reduction in time to thrombolysis and also captures more patients within the “golden hour” window. Historically, IV tPA recanalization rates for emergent large vessel occlusion (ELVO) strokes have been low. We present our initial experience of ELVO strokes treated in the MSTU within the “golden hour”.

Methods We reviewed our MSTU registry to identity ischemic stroke patients with ELVO and treated with IV tPA. Demographics, clinical and imaging data for the patients were collected.

Results During the initial 32 weeks in service the MSTU had 743 dispatches and transported 195 patients. Eight patients met inclusion criteria, of which 5 patients received IV tPA in under 60 min from symptom onset. All the 5 patients were males with a median age of 76 [interquartile ranges (IQR) 73–77]. Median national institute of health stroke scale (NIHSS) at initial presentation was 16 (IQR 16–19) with median time of symptom onset to IV tPA 51 min (IQR 46–56). Initial vascular imaging identified 2 patients with proximal middle cerebral artery (MCA) occlusion, 1 distal MCA occlusion, 1 carotid terminus and 1 basilar apex occlusion. Four patients underwent angiogram for thrombectomy and 1 had follow up MRA. Of these only 1 patient required mechanical thrombectomy while others had spontaneous recanalization with 3 showing thrombolysis in cerebral infarction (TICI) 2b grade of reperfusion and one having TICI 3 reperfusion. Median time from IV tPA to angiogram/MRA was 90 min (IQR 80–101). Median discharge NIHSS was 1 (IQR 0–3).

Conclusion Our initial data shows that MSTU may be able to improve IV tPA recanalization rates for ELVO strokes as it is able to procure more patients in the “golden hour”.

Disclosures R. Cerejo: None. A. Taqui: None. A. Itrat: None. S. John: None. K. Uchino: None. G. Toth: None. P. Rasmussen: None. M. Hussain: None.

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