A new study shows that mobile stroke units (MSUs) equipped with a computed tomographic (CT) scanner enable faster treatment with tissue plasminogen activator (t-PA) of stroke patients than standard management by emergency medical services (EMS).

Researchers at the University of Texas Health Science Center (UTH; Houston, USA), Memorial Hermann Health System (MHHS; Houston, TX, USA), and other institutions conducted an observational, prospective, multicenter, alternating-week trial to assess outcomes of care management within 4.5 hours of onset of acute stroke symptoms in 1,047 patients, in order to evaluate t-PA administration by MSUs (617 patients), as compared to standard management by EMS (430) teams.

The results showed median time from onset of stroke to t-PA administration was 72 minutes in the MSU group and 108 minutes in the EMS group. Of patients eligible for t-PA, 97.1% in the MSU group received it, as compared with 79.5% in the EMS group. Mean score on the utility-weighted modified Rankin scale (at discharge) was 0.57 in the MSU group, and 0.51 in the EMS group, with secondary clinical outcomes generally favoring MSUs. Ninety day mortality was 8.9% in the MSU group and 11.9% in the EMS group. The study was published on September 8, 2021, in the New England Journal of Medicine (NEJM).

“A potential way to reduce the time from stroke onset to treatment is with mobile stroke units ... which are ambulances equipped with a CT scanner, point-of-care laboratory testing, and personnel trained to diagnose and treat patients with stroke in the ambulance, including administration of tPA and triage for endovascular thrombectomy,” concluded lead author James Grotta, MD, of MHHS, and colleagues. “Mobile stroke units have the potential to increase the frequency and speed of the delivery of tPA treatment.”

tPA is a serine protease found on endothelial cells. Its enzymatic role is to catalyze the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown. It is thus contraindicated in hemorrhagic stroke and head trauma. When manufactured using recombinant biotechnology methods, it is referred to as recombinant tissue plasminogen activator (rtPA), used to treat embolic or thrombotic stroke. 

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