Comparison of Drip‐and‐Ship Versus Mothership Delivery Models of Mechanical Thrombectomy Delivery

Abstract

BACKGROUND It remains uncertain whether the drip‐and‐ship (DS) strategy (transport to the nearest primary stroke centers) or the mothership (MS) model (direct transportation to the comprehensive stroke center) is the organizational stroke model associated with the best functional outcome in acute stroke patients with large vessel occlusion. In this study, we compared the periprocedural complications and outcomes at 90 days of acute stroke patients with large vessel occlusion of the anterior circulation directly admitted to our comprehensive stroke center compared to those referred from primary stroke centers treated with mechanical thrombectomy. METHODS This is a single‐center prospective observational study where patients with DS and MS were compared regarding the disability at 90 days, as assessed by applying the modified Rankin scale, the rate of successful reperfusion, and the rate of immediate complications postprocedure. RESULTS Of 579 patients, 216 (37.30%) were MS, and 363 (62.7%) were DS. There was no difference regarding the modified Rankin scale at 3 months between the MS (36.4%) and DS (39.3%) groups of patients treated with mechanical thrombectomy ( P =0.362). There was no significant difference regarding the National Institutes of Health Stroke Scale at 24 hours, mortality at 90 days, and rate of successful recanalization postprocedure between the 2 groups. DS was associated with an increased risk of hemorrhagic transformation and symptomatic intracranial hemorrhage (odds ratio, 5.414 [95% CI, 1.572–18.644]; P =0.007). CONCLUSION Our single‐center study showed no difference in terms of functional independence between the DS and MS organizational paradigm. DS was associated with an increased risk of hemorrhagic transformation and symptomatic intracranial hemorrhage.

Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation

“…The Stroke Department at Charing Cross Hospital is the Northwest London (UK) regional Comprehensive Stroke Centre (CSC) for MT in an urban metropolitan area with more than 6.4 million people. Please refer to our previous manuscripts for the organization of the Imperial Stroke Thrombectomy network [ 22 , 23 ].…”

Safety and outcomes of different endovascular treatment techniques for anterior circulation ischaemic stroke in the elderly: data from the Imperial College Thrombectomy Registry

“…The Stroke Department at Charing Cross Hospital is the Northwest London (UK) regional Comprehensive Stroke Center (CSC) for MT in an urban metropolitan area with more than 6.4 million people. Please refer to our previous manuscripts for the organization of the Imperial Stroke Thrombectomy network [ 14 , 15 ]. In 2019, the life expectancy at birth in London was 85.4 years for women and 81.6 years for men [ 16 ].…”

Epidemiology, organization, diagnosis and treatment of acute ischemic stroke

“…Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) represent the standard of care in acute stroke patient with LVO [14] . The MT is available at comprehensive stroke center (CSCs) whereas the primary stroke centers (PSC) can administer only IVT [15] . Therefore, two main prehospital stroke systems of care have been developed: the mothership (MS), in which the patient is directly brought to the CSC, and the drip and ship (DS) model, where initially the patient is brought to the PSC to have diagnostic imaging and eventual administration of IVT followed by transport to the CSC.…”

“…Therefore, two main prehospital stroke systems of care have been developed: the mothership (MS), in which the patient is directly brought to the CSC, and the drip and ship (DS) model, where initially the patient is brought to the PSC to have diagnostic imaging and eventual administration of IVT followed by transport to the CSC. The choice of a model over another implies clinical consequences for treated patients as well as for local health policies, including the distribution of hospital facilities over the region of interest [15] , [16] .…”

“…Indeed interhospital transfer of patients with acute ischemic stroke is associated with delay of endovascular treatment and worse outcomes in routine clinical practice, even in a country where between center distances are short [18] . Rapid access to MT for patients with LVO is critically associated with their functional outcome [15] .…”