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

Background: 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).

Methods: 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.

Results: 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%).

Conclusion: 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.