Memorial Hermann Hospital
Neurology
Dr. James Grotta received his education at Dartmouth College, the Universities of Virginia and Colorado, and Massachusetts General Hospital. After joining the UT Houston faculty in 1979, he established the UT Houston Stroke Program and developed its NIH funded fellowship training program. He has been continuously funded to carry out translational research in acute stroke treatment, and played a leading role in many clinical research studies, including the NINDS TPA Stroke Study. In 2013, Dr. Grotta stepped down as department chair and moved his practice to Memorial Hermann Hospital to lead the Mobile Stroke Unit Consortium, the nation's first Mobile Stroke Unit to deliver TPA and other stroke therapies wherever the stroke occurs. In 2021 he completed a prospective multicenter comparative effectiveness study of this novel approach to acute stroke treatment. He edits the most authoritative textbook on Stroke, has published over 500 scientific manuscripts, and has received numerous awards for his research, clinical work and mentoring.

Moderator Of 1 Session

Session Type
Plenary Session
Date
28.10.2021, Thursday
Session Time
19:15 - 20:45
Room
PLENARY
Session Icon
Live Session

Presenter Of 1 Presentation

Latest Trial Results from BEST-MSU

Session Type
Plenary Session
Date
28.10.2021, Thursday
Session Time
19:15 - 20:45
Room
PLENARY
Lecture Time
19:15 - 19:29

Abstract

Abstract Body

Mobile Stroke Units (MSUs) provide pre-hospital stroke treatment vs EMS transport and subsequent treatment in the ED. BEST-MSU is a prospective trial comparing MSU to EMS management on alternate weeks in patients with suspected acute stroke within 4.5 hrs of onset. Primary outcome was the utility-weighted modified Rankin scale (uw-mRS, range 0 to 1, higher score representing better outcome). The main analysis was of dichotomized uw-mRS >/= 0.91 vs < 0.91 (equivalent to mRS </=1 vs > 1) at 90 days in patients adjudicated tPA-eligible.

We enrolled 1,515 patients at 7 U.S. cities. 617 MSU and 430 EMS patients were tPA-eligible. Median time (min) from stroke onset to tPA was 72 MSU vs 108 EMS; 33% of tPA-eligible MSU pts were treated within 60 min of onset vs 3% EMS. 97% of tPA-eligible MSU patients actually received tPA vs 80% with EMS. Mean 90-day uw-mRS for tPA-eligible patients was 0.72 vs 0.66 for MSU vs EMS (adjusted odds ratio [OR] for MSU vs EMS of uw-mRS >/= 0.91, 2.43; 95% CI, 1.75 to 3.36; p < 0.001). The proportions of tPA-eligible patients achieving mRS of 0 or 1 at 90 days was 55% for MSU vs 44% for EMS. For all enrolled patients mean discharge uw-mRS was 0.57 vs 0.51 for MSU vs EMS (OR, 1.82; 95% CI, 1.39 to 2.37; p< 0.001). All secondary outcomes also favored MSU.

In tPA-eligible acute stroke patients, MSU management resulted in faster and more frequent tPA treatment, and less disability at 90 days.

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