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Updated: Mar 21, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Poor Hypertension Control and Longer Transport Times Are Associated with Worse Outcome in Drip-and-Ship Stroke
Thomas V Kodankandath1, Jane Shaji1, Nina Kohn1
1Department of Neurology, North Shore University Hospital, Manhasset, New York.
Insights
Inadequate blood pressure control and longer transport times during drip-and-ship transfers for acute ischemic stroke (AIS) patients are linked to poor outcomes. Strict blood pressure management and optimized transfer methods are recommended.
Area of Science:
- Neurology
- Emergency Medicine
- Cardiovascular Medicine
Background:
- The drip-and-ship model is crucial for acute ischemic stroke (AIS) patients lacking immediate access to comprehensive stroke centers (CSCs).
- This approach involves initiating intravenous thrombolysis at a primary stroke center before transferring patients to a CSC.
Purpose of the Study:
- To identify factors associated with adverse outcomes in AIS patients undergoing drip-and-ship transfers to a CSC.
- To evaluate the impact of transport blood pressure control and transfer duration on patient outcomes.
Main Methods:
- Retrospective analysis of 130 drip-and-ship AIS patients transferred to a single CSC.
- Factors analyzed included patient characteristics and transport variables.
- Inadequate blood pressure control defined as systolic BP > 180 mmHg or diastolic BP > 105 mmHg upon CSC arrival.
Main Results:
- Inadequate blood pressure control upon CSC arrival significantly correlated with in-hospital mortality or hospice discharge (P < .0007).
- Longer transport times were significantly associated with poorer modified Rankin Scale (mRS) scores and increased mortality (P < .0174 and P < .0351, respectively).
- Arrival blood pressure was not linked to symptomatic intracerebral hemorrhage risk.
Conclusions:
- Violations of post-thrombolysis blood pressure guidelines and extended transport times in drip-and-ship transfers are linked to poor patient outcomes.
- Recommendations include strict adherence to transport blood pressure management protocols.
- Consideration of alternative transfer methods for longer distances may improve outcomes.
Background:
The "drip-and-ship" paradigm is an important treatment modality for acute ischemic stroke (AIS) patients who do not have immediate access to a comprehensive stroke center (CSC). Intravenous thrombolysis is initiated at a primary stroke center followed by expeditious transfer to a CSC. We sought to determine factors associated with poor outcomes in drip-and-ship AIS patients transferred to a CSC.
Methods:
This study is a retrospective analysis of 130 consecutive drip-and-ship patients transferred by ambulance to a single CSC between July 2012 and June 2014. Multiple patient and transport factors were analyzed. Transport blood pressure (BP) control was considered inadequate if the systolic BP was greater than 180 mmHg and/or diastolic BP was greater than 105 mmHg upon CSC arrival. Poor patient outcome was defined as discharge to hospice or expiry, a discharge modified Rankin Scale (mRS) score higher than 2, or symptomatic intracerebral hemorrhage (ICH).
Results:
There was a significant association between inadequate BP control upon CSC arrival and in-hospital mortality or discharge to hospice (P < .0007). Arrival BP was not associated with the risk of post-thrombolysis symptomatic ICH. Longer transport time was significantly associated with a poorer mRS score at discharge (P < .0174) and death (P < .0351).
Conclusions:
Post-thrombolysis BP guideline violations and longer transport times during drip-and-ship transfers were significantly associated with poor outcome. Guidelines for strict transport BP management and alternative modes of transfer for longer-distance transports may be warranted.
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