OBJECTIVES: In ischaemic stroke care, fast reperfusion is essential for disability free survival. Mechanical thrombectomy (MT) is recommended for treatment of acute ischemic stroke (AIS) in patients with large vessel occlusion (LVO). Given the expertise required for MT, it is available only at the comprehensive stroke centers (CSC). It is unknown if bypassing primary stroke centers (PSC) in favor of MT (mothership) outweighs transport to the nearest PSC for alteplase and then transfer to CSC for MT (drip-and-ship) for LVO patients.

METHODS: We retrospectively analyzed 176 consequtive LVO patients (78 in the mothership group and 98 in the drip-and-ship group). We evaluated 3-month functional modified Rankin Score (mRS) and thrombolysis in cerebral infarction (TICI) score. Statistical analysis employed a multivariate logistic regression model, including significant co-variates, to compare patients in the mothership versus drip-and-ship groups.

RESULTS: Co-variate analyses revealed that the mothership and drip-and-ship groups were not statistically different in the following variables, respectively: IV-tPA utilization (65% versus 73%, P=0.245), TICI 2b-3 (89% versus 87%, P=0.736), symptom onset time distribution as 0-4.5 hours, >4.5-6 hours and >6-24 hours (82%, 8%, 10% versus 76%, 12%, 11%, P=0.670), age distribution as <50, 50-80, >80 (12%, 59%, 29% versus 13%, 63%, 23%, P=0.658), presence of diabetes (21% versus 23%, P=0.639), and NIHSS distribution as 0, 1-4, 5-9, 10-42 (0%,3%,4%,94% versus 1%, 0%, 6%, 93%, P=0.289). After multivariate logistic regression, the predictive factors for favourable outcomes were initial NIHSS (OR=0.9, P=0.040), absence of diabetes among obese patients (OR=13.89, P=0.032), and mothership model if PCS was located more than 12 minutes drive from CSC (OR=4, P=0.045).

CONCLUSIONS: This study found that LVO patient treated under the mothership paradigm had signficantly improved clinical outcomes after mechanical thrombectomy compared to the drip-and-ship model if the time-to-transfer from the PSC to the CSC was more than 12 minutes.