New York City Mobile Interventional Stroke Team

Study Overview
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Brief Summary
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Endovascular treatment has recently become the recommended therapy for acute stroke after the publication of five randomized trials (MR CLEAN1, ESCAPE2, EXTEND IA3, SWIFT PRIME4, REVASCAT5) in 2015 that demonstrate its efficacy. Hospitals need to adapt to these updated stroke care guidelines, and many hospitals are not appropriately equipped for neurointerventional procedures. Decreased time to treatment is associated with favorable clinical outcomes, and best practices to optimize workflow between comprehensive stroke centers and secondary hospitals have become an important area of study. This prospective study is being conducted on acute stroke cases within the Mount Sinai Health System from 1 June 2016 up until 31 December 2018. The researchers would like to evaluate how variable methods of interventional service delivery for acute stroke affect clinical measures and outcomes. More specifically, the researchers are conducting this study in order to determine whether outcomes of neurointervention for large vessel occlusion in stroke, for patients presenting to and receiving treatment at a comprehensive stroke center, will be superior to that delivered by a mobilized intervention team at a central satellite hospital. In particular, the hypothesis is that factors affecting outcome include presentation to secondary hospital, delays with transfer including traffic conditions and time of day, and the acquisition of complex imaging within secondary hospitals.

Official Title
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Reducing Disparities in Mechanical Embolectomy Access for Patients of New York City Via a Mobile Interventional Stroke Team: Systems of Care and Time-To-Treatment

Conditions
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Acute Stroke

Intervention / Treatment
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* Other: Acute Endovascular Stroke Treatment


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: - all patients who consent to the study and present with acute stroke treated with thrombectomy in the Mount Sinai Health System (Mount Sinai, Mount Sinai West, Mount Sinai Beth Israel, Mount Sinai St. Luke's) from 1 June 2016 - 31 December 2018. Exclusion criteria: If the patient is pregnant Under age 18 A prisoner. If timing of treatment cannot be captured, patients with these data points will be excluded.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mobilized Neurointervention Team<br>Patients undergoing endovascular stroke interventions. | Other: Acute Endovascular Stroke Treatment<br> <br> * Other names: Microvention;|
| Mobilized Patient<br> | Other: Acute Endovascular Stroke Treatment<br> <br> * Other names: Microvention;|
| Core Comprehensive Stroke Center Treatment<br> | Other: Acute Endovascular Stroke Treatment<br> <br> * Other names: Microvention;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Treatment times | Time between first hospital arrival and final recanalization | 90 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to groin puncture procedure | Time of first hospital arrival to groin puncture | 3 months | 
| Time of EMS contact to groin puncture |  | 90 days | 
| NIHSS | National Institutes of Health Stroke Scale (NIHSS) a 11-item impairment scale to evaluate neurologic outcome and degree of recovery. Each item is scored between 0 and up to 4, (0 normal function with higher score indicating higher level of impairment. with minimum score 0 and maximum possible score 42. | 90 days | 
| modified Rankin Scale (mRS) | the mRS measures degree of disability/dependence after a stroke. the mRS is a scale that runs from 0 (no symptoms) to 6 (death). | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Acute, Endovascular, Cerebrovascular, Clot, Embolectomy, Embolus, Thrombectomy, Thrombolysis, Thrombus, Mobile, Interventional, Neurointervention, Stroke, Ischemic, Stent Retriever, Tissue Plasminogen Activator, Drip and Ship, Mothership, Trip and Treat