Mobile Interventional Stroke Team Results in Better Early Outcomes in ELVO Stroke

A Mobile Interventional Stroke Team (MIST) resulted in improved clinical outcomes for emergent large vessel occlusion (ELVO) stroke.

A Mobile Interventional Stroke Team (MIST) was associated with significantly faster initial door-to-recanalization times and improved clinical outcomes compared with a standard drip-and-ship (DS) model, according to study results published in Stroke.

A MIST travels to the hospital where a patient presents with emergent large vessel occlusion (ELVO) stroke to perform endovascular therapy while the patient is prepped in the angiography suite. Contrastingly, the DS model transports patients to the nearest hospital to reduce time to intravenous tissue-type plasminogen activator with a subsequent transfer to a comprehensive stroke center for endovascular therapy. This study, led by a Mount Sinai research team, compared the MIST model with the DS model in terms of time-efficiency and clinical outcome improvements in patients presenting with large vessel occlusion stroke.

A total of 228 patients with 3-month follow-up data were included in this observational study. Study researchers also compared MIST with the mothership model, which includes transporting patients directly to the nearest comprehensive stroke center to reduce the time to endovascular therapy. The duration from initial door-to-recanalization and final recanalization from successful endovascular therapy comprised the primary endpoint.

A total of 20 patients received care under the mothership model, 114 patients received care under the DS model, 64 patients received care under the MIST model, and another 30 patients fit criteria for a combination of DS and MIST (mean age of overall cohort, 68.5±14.0 years; 51.8% women).

The use of MIST was associated with a significantly faster mean initial door-to-recanalization time compared with DS (214.9±85.6 vs 297.9±114.9 minutes, respectively; P <.0001). There was no significant difference between MIST and mothership regarding the median door-to-recanalization times (192 vs 179 minutes, respectively; P =.83). 

A significantly greater proportion of patients in MIST had a complete recovery (National Institutes of Health Stroke Scale of 0 or 1) at discharge compared with patients in the DS model (37.9% vs 16.7%; P =.0025). 

Compared with DS, the MIST model was associated with significantly lower median initial door-to-puncture time (202.5 vs 130.5 minutes; P <.0001) and time of EMS contact-to-puncture (232 vs 158 minutes; P <.0001).

Limitations of this study included its observational design, the inclusion of patients from a largely metropolitan setting, and potential confounders, such as patient cohort allocation.

The study researchers concluded that MIST represents “an alternative to the DS model in select geographies and allows for time-to-treatment intervals and clinical outcomes similar to the mothership model.”


Morey JR, Oxley TJ, Wei D, et al. Mobile interventional stroke team model improves early outcomes in large vessel occlusion stroke: The NYC MIST trial. Stroke. Published online November 2, 2020. doi:10.1161/STROKEAHA.120.030248