Safety and Effectiveness of Drip, Ship, and Retrieve Paradigm for Acute Ischemic Stroke: a Single Center Experience

Abstract

This study analyzed the efficacy and safety of the “drip, ship, and retrieve (DSR)” approach used to improve patient access to thrombectomy for acute stroke. Methods: The study participants were 45 patients who underwent thrombectomy following intravenous tissue plasminogen activator between September 2013 and August 2015. Patients were divided into two groups according to whether they were transferred from another hospital (DSR group; n = 33) or were brought in directly (Direct group; n = 12). The two groups were compared based on their baseline characteristics, time from stroke onset to reperfusion, outcome, and adverse events. Results: There were no significant differences in baseline characteristics. Time from onset until admission to our facility was significantly shorter in the Direct group (56.9 min) than in the DSR group (163.5 min) (P <0.0001). Conversely, time from arrival at the hospital to arterial puncture was significantly shorter in the DSR group (25.0 min) than in the Direct group (109.5 min) (P <0.0001). Time from onset to reperfusion did not differ significantly between the groups. There was no significant difference in patient outcomes, with a modified Rankin scale score of 0–2 (44.8% in DSR group versus 48.7% in Direct group). Moreover, there was no difference in the incidence of adverse events. Discussion: Despite the time required to transfer patients in the DSR group between hospitals, reducing the time from arrival until commencement of endovascular therapy meant that the time from onset to reperfusion was approximately equivalent to that of the Direct group. Conclusion: Time-saving measures need to be taken by both the transferring and receiving hospitals in DSR paradigm.

Systematic review of organizational models for intra-arterial treatment of acute ischemic stroke

“…The patient can be given intravenous thrombolytic treatment in the ambulance and transported to the appropriate stroke center. articles included in qualitative analysis 9 articles included in quantitative analysis 28,[30][31][32][33]35,[37][38][39] 18 articles excluded from quantitative analysis: -one organizational model only 25,34 -models used intravenous thrombolytic treatment only (no intra-arterial treatment) 15,17,18,20,22,23 -models used different recanalisation treatments 16,21 -no information about clinical outcome 13,14,19,24,26,27,29,34,36,51 International Journal of Stroke, 14(1) The mother-ship model was used for the majority of the patients in the completed randomized-controlled trials of intra-arterial treatment. 21,[26][27][28] The observational studies showed that the drip-and-ship model is frequently used in clinical practice in many countries (United States, South Korea, Spain, Germany, Italy, and France), whereas there were few reports of the mobile stroke unit and the mobile interventionist models in the medical literature.…”

“…A total of nine studies 28,[30][31][32][33]35,[37][38][39] reported outcomes of patients treated with intra-arterial therapy under different models, and were included in the quantitative analysis. The studies included a total of 4127 patients, from eight observational studies 28,[30][31][32][33]35,[37][38][39] and one randomized-controlled trial of intra-arterial therapy. 28 All studies compared the mother-ship and the dripand-ship models, and Figure 2 presents data on the process performance of these models.…”

Mothership versus Drip-and-Ship Model for Mechanical Thrombectomy in Acute Stroke: A Systematic Review and Meta-Analysis for Clinical and Radiological Outcomes

“…Systematic search retrieved 18 studies including 7,017 patients (PRISMA flowchart) ( Figure 1). [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Most of the included studies were observational and prospective, only one study was a RCT 15 (Table 1). As a result, quality of studies ranged fair to good, with only one RCT achieving optimal score on risk of bias assessment.…”

Efficacy of the Drip and Ship Method in 24-h Helicopter Transportation and Teleradiology for Isolated Islands

“…Other previous studies have reported the safety and effectiveness of the DSR approach in AIS. 7,21) In this study, seven patients living on the islands were treated via the DSR method; of these, three patients had favorable outcomes, and four of seven patients transported via the DSR method in the Islands group had successful reperfusion (Table 3).…”