Integrated drip-and-ship improves stroke transfer efficiency and outcomes: a comparison with traditional drip-and-ship and mothership models.

Abstract

While endovascular thrombectomy (EVT) has revolutionized the treatment of acute large vessel occlusions, the appropriate patient transfer paradigm remains controversial. This study compares outcomes of three transfer models in a stroke network: mothership (MS), traditional drip-and-ship (DS), and an integrated DS model using a novel transfer system (TS). We implemented a novel TS to streamline communication and coordination between primary and comprehensive stroke centers. We analyzed 1063 patients with suspected large vessel occlusion across three groups: MS (n=814), conventional DS without TS (DS TS (-), n=185), and DS with TS (DS TS (+), n=64). Primary outcomes included treatment time metrics, EVT rates, and functional outcomes. DS TS (+) showed improved time metrics, with onset-to-CT angiography (CTA) times comparable to MS (232 vs 255.5 min) and significantly faster than DS TS (-) (305 min). It also achieved the highest rates of both intravenous thrombolysis (51.56%) and EVT (48.44%). Among EVT patients, the DS TS (+) group had the shortest door-to-puncture time (98.0 min vs MS 132.0 min and DS TS (-) 127.0 min, P<0.001) and a shorter onset-to-puncture time compared with the DS TS (-) group. DS TS (+) also showed a promising trend towards superior functional outcomes at 3 months (modified Rankin Scale score 0-2: 54.84% vs MS 39.10% vs DS TS (-) 36.36%). This study shows that an integrated DS model using a structured TS can achieve outcomes comparable to the MS model. Enhancing transfer efficiency through innovative solutions tailored to the regional infrastructure may serve as a viable alternative alongside the MS model.