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Related Concept Videos

Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

54
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
54

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Mothership Versus Drip-and-Ship Models in Acute Stroke Care: A Time-Sensitive Meta-Analysis.

Lucio D'Anna1,2, Lorenzo Barba3, Samir Abu-Rumeileh3

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The mothership and drip-and-ship models for mechanical thrombectomy in acute ischemic stroke show similar functional outcomes. However, delays in treatment significantly impact outcomes, favoring direct transport to capable centers when delays exceed 43 minutes.

Keywords:
drip‐and‐shipmothershipthrombectomy

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Area of Science:

  • Neurology
  • Interventional Cardiology
  • Public Health

Background:

  • Mechanical thrombectomy is standard for large vessel occlusion ischemic stroke.
  • The optimal care model (mothership vs. drip-and-ship) remains debated.
  • This study compares functional and safety outcomes between these models.

Purpose of the Study:

  • To compare functional and safety outcomes of mothership vs. drip-and-ship mechanical thrombectomy.
  • To assess the impact of onset-to-groin puncture delay on outcomes.
  • To identify thresholds for superior outcomes based on care model and delay.

Main Methods:

  • Systematic review and meta-analysis of randomized trials and cohort studies.
  • Included patients with anterior circulation large vessel occlusion undergoing mechanical thrombectomy.
  • Primary outcome: 90-day functional independence (modified Rankin Scale 0-2).

Main Results:

  • No significant difference in 90-day functional independence between mothership and drip-and-ship models.
  • Longer onset-to-groin delays in drip-and-ship significantly reduced functional independence (P<0.001).
  • A 43-minute delay threshold identified, beyond which mothership model showed superior outcomes.

Conclusions:

  • Direct transport to a thrombectomy-capable center is preferred when secondary transfer causes treatment delay.
  • Functional outcomes significantly worsen beyond a 43-minute delay threshold.
  • Prioritizing direct transport optimizes outcomes for large vessel occlusion stroke patients.