Comparison between "Mothership" and "Drip and Ship" models in the management of acute ischemic strokes eligible for mechanical thrombectomy in the Charleroi area, Belgium.

BACKGROUND: In the management of acute ischemic stroke with large vessel occlusion (LVO-AIS), current data are conflicting as to whether a mothership model of management (MS) is associated with better functional recovery than a drip-and-ship model (DS).

METHOD: Files from LVO-AIS patients treated with MT at CHU Charleroi were analyzed between 01/01/2017 and 12/31/2022. Consecutive patients with a LVO-AIS of the anterior circulation and a prestroke modified Rankin Scale (mRS) ≤2 were included. The study's primary endpoint was the functional independence, defined as a mRS of 0-2 at 3 months post-stroke. Times metrics of MT and thrombolysis application, safety outcome including symptomatic intracranial hemorrhage and death were recorded. We conducted similar analyses by dividing DS patients, depending of their transfer time (less or more than 20 minutes). Logistic regression was used to assess if differences in baseline characteristics affected the primary outcome.

RESULTS: 366 patients were included: 229 in the DS group and 137 in the MS group. Demographic data showed a higher rate of tobacco use and lower functional status prestroke in the MS population. The MS group demonstrated better performance in time metrics related to thrombolysis and MT administration. The proportion of patients achieving an mRS of 0-2 at 3 months was similar in the DS and MS groups (50.22% vs. 48.17%, p = 0.706). The same conclusions were drawn from the subgroup analysis. Logistic regression analysis showed no impact of baseline characteristic differences on the primary outcome.

CONCLUSION: Despite faster access to MT in the MS model, our study did not find any significant differences in functional recovery at three months post-stroke between the MS and DS management models. Our data suggest further that the prestroke health status was an important factor influencing functional outcomes after LVO-AIS.