Mobile Stroke Unit (MSU): The Future of Acute Stroke Treatment

Abstract

of intravenous recombinant tissue Plasminogen Activator (IV rtPA) are highly dependent
on time.1-3 Stroke patients presenting within the first 60 minutes, or the golden hour, are the
most likely to benefit from recanalization therapy.1-3 Thus, making rapid clinical and imaging
evaluation of stroke patients of upmost importance and very difficult to complete within the
golden hour time window. Based on Get with the Guidelines-Stroke Program (April 2003 to
October 2009), less than one-third of patients treated with IV rtPA have door-to-needle times
of less than 60 minutes.4
However, the delivery of care to a stroke victim is complex and involves pre-hospital
and in-hospital stages. Once the patient arrives in a hospital, the recommended door-to-needle
time is less than 60 mins.5 Despite combined efforts to streamline procedures in hospitals to
provide treatment as soon as possible, most places are challenged to stay within this time
window.4,6 In fact, most patients are still treated with considerable delay and very few of them
receive intravenous tissue Plasminogen Activator (tPA) within 90 mins after symptom onset.6
While the number needed to treat in order to achieve a modified Rankin Scale (mRS) of 0-1 is
only 4.5 when treatment is provided within 90 mins, it raises to 9 between 90 and 180 mins and
exceeds 14 by 4.5 h.2