Mobile Stroke Units Maintain Efficacy and Safety During Real-World Use in Acute Stroke

Introduction Randomized trials (RT) are the gold standard for evaluating novel interventions, yet their controlled conditions may limit generalizability to real‐world (RW) clinical practice. The BEST‐MSU trial demonstrated that mobile stroke units (MSUs) significantly reduced time from LKW to intravenous thrombolysis (IVT) in acute ischemic stroke patients, without increasing safety concerns such as symptomatic intracerebral hemorrhage (sICH). This study examines whether MSU care in RW clinical settings sustains the efficacy and safety observed in the BEST‐MSU trial. Methods We conducted a retrospective analysis of MSU‐treated patients who received IVT across a large metropolitan hospital system from November 2023 to August 2025. These patients (RW cohort) were compared to a matched cohort from the BEST‐MSU trial (RT cohort). The primary outcome was time from last known well (LKW) to IVT. Secondary outcomes include thrombolytic treatment rate, MSU alert to IVT time, LKW to endovascular thrombectomy (EVT) time, MSU alert to EVT time, and symptomatic ICH rate. Group comparisons were conducted using Chi‐squared tests for categorical variables and Wilcoxon rank‐sum tests for continuous variables. Results A total of 750 patients were analyzed: 106 in the RW cohort and 644 in the RT cohort. Baseline characteristics were comparable between the groups, including age, sex, stroke severity (NIHSS), and pre‐stroke disability (mRS). Median LKW to IVT times were comparable (RW 79.5 minutes vs RT 73, p=0.068) as were MSU alert to IVT time (39.0 min vs RT 37.0, p=0.209). Thrombolytic treatment rates were maintained between cohorts (24% vs 20%, p=0.404). The sICH rate was higher in the RW cohort (7.5% vs 2.0%, p=0.004), though ICH type was similar (p=0.594). Among patients who also underwent EVT, RW patients had a longer LKW to MSU alert time, but MSU alert to EVT puncture and reperfusion were comparable between groups. Conclusion MSU care in the real‐world continues to enable rapid IVT administration in acute ischemic stroke, with treatment times and thrombolytic rates comparable to those observed in a randomized trial setting. These findings support the scalability and clinical utility of MSUs beyond controlled trial environments.