Mobile Stroke Units in Acute Ischemic Stroke: Thrombectomy Efficiency, Workflow Models, and Implementation Considerations: A Review

Background: Acute ischemic stroke (AIS) is a time-critical emergency in which the benefit of reperfusion depends not only on treatment speed but also on accurate large-vessel occlusion (LVO) recognition, destination selection, and coordination between prehospital and hospital teams. Mobile stroke units (MSUs) move imaging, laboratory testing, specialist assessment, and thrombolysis into the prehospital setting, but their effect on thrombectomy depends substantially on onboard vascular-imaging capability and local routing protocols. Summary: This narrative review evaluates MSUs through the broader construct of thrombectomy efficiency, encompassing LVO identification, destination accuracy, avoidance of secondary transfer and duplicate imaging, in-hospital parallel processing, puncture and reperfusion times, and downstream clinical outcomes. Evidence for earlier intravenous thrombolysis is retained as an important upstream benefit but is distinguished from thrombectomy-specific efficiency. The available literature indicates that non-contrast-CT–based MSUs can accelerate hospital workflows through early diagnosis and prenotification, whereas CTA-enabled models can additionally confirm LVO in the field and support direct routing to a thrombectomy-capable center or, in selected systems, direct-to-angiography pathways. The magnitude of benefit is therefore configuration- and system-dependent. Economic evaluations likewise show that value is highly sensitive to annual patient volume, catchment population, staffing model, operating hours, analytic time horizon, and baseline patient disability. Key Messages: MSUs should not be treated as a uniform intervention. Their thrombectomy value is determined by how effectively prehospital imaging and specialist assessment are linked to destination decisions, interfacility-transfer avoidance, and receiving-center activation. CTA-enabled pathways provide the clearest mechanism for thrombectomy-specific time savings, while non-contrast-CT-based models may still improve in-hospital efficiency. Implementation is most defensible when local geography, case volume, workforce, dispatch integration, downstream thrombectomy capacity, and cost-effectiveness are considered together.