Drip and ship and mothership models of mechanical thrombectomy result in similar outcomes in acute ischemic stroke of the anterior circulation.

Autor: Brochado AP; Osakidetza Basque Health Service, Galdakao University Hospital, Department of Neurology, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute., Muras AC; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Department of Neurology, Vizcaya, Spain., Oyarzun-Irazu I; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Department of Neurology, Vizcaya, Spain., Rodriguez-Sainz A; Osakidetza Basque Health Service, Galdakao University Hospital, Department of Neurology, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute., Caballero-Romero I; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Department of Neurology, Vizcaya, Spain., Aguilera-Irazabal B; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Department of Neurology, Vizcaya, Spain., García-Sánchez JM; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Department of Neurology, Vizcaya, Spain., Sustatxa-Zárraga I; Osakidetza Basque Health Service, Galdakao University Hospital, Department of Neurology, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute., Martínez-Condor D; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Department of Neurology, Vizcaya, Spain., Gutierrez-Albizuri C; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Department of Neurology, Vizcaya, Spain., Bilbao-González A; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Vizcaya, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) Kronikgune, Vizcaya, Spain., Gómez-Beldarrain M; Osakidetza Basque Health Service, Galdakao University Hospital, Department of Neurology, Vizcaya, Spain; Biocruces Bizkaia Health Research Institute., García-Moncó JC; Biocruces Bizkaia Health Research Institute.; Osakidetza Basque Health Service, Basurto University Hospital, Department of Neurology, Vizcaya, Spain. Electronic address: hospit05@sarenet.es.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2022 Oct; Vol. 31 (10), pp. 106733. Date of Electronic Publication: 2022 Aug 26.
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106733
Abstrakt: Background: Stroke therapy has been transformed in recent years due to the availability of thrombolysis and mechanical thrombectomy (MT). Whether transferring the patient directly to a comprehensive stroke center (CSC, mothership model) is better than taking them to a primary stroke center (PSC) and then to a CSC for MT (drip and ship) is unclear but has important implications. We compared the performance of both models in a district of the Basque country, Spain.
Methods: This is a retrospective analysis of prospectively collected data of all acute ischemic stroke patients consecutively admitted to the Neurology Department of two institutions and eligible for MT over a 36-month period with anterior circulation large vessel occlusion (LVO). One center applied the mothership model and the other the drip-and-ship. The two models were compared in terms of mortality and functional status assessed by modified Rankin (mRS) scale at 90 days. As a surrogate of the effectiveness of the two models, all times pertinent to stroke therapy were recorded.
Results: A total of 187 patients were evaluated subjected to MT with the drip-and-ship model and 188 with mothership, with a median NIHSS of 15. Prior to MT, 17% of the drip-and-ship patients received thrombolysis and 26% in the mothership. Neither mortality rate nor mRS showed statistically significant differences 90 days after stroke. The time lapse from stroke to MT was optimal in both models; albeit being 10 minutes longer in the drip-and-ship model, it had no impact on patients' outcomes.
Conclusions: Drip-and-ship and mothership models can provide optimal and similar results in acute stroke patients in terms of mortality and functional status at 90 days. Their coexistence may alleviate the burden of CSC thus facilitating the access of more stroke patients to advanced therapies in an equitable manner.
Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest regarding this manuscript.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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