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Review
. 2020 Sep;22(3):317-323.
doi: 10.5853/jos.2020.01767. Epub 2020 Sep 29.

Mothership versus Drip-and-Ship Model for Mechanical Thrombectomy in Acute Stroke: A Systematic Review and Meta-Analysis for Clinical and Radiological Outcomes

Michele Romoli  1   2 , Maurizio Paciaroni  3 , Georgios Tsivgoulis  4   5 , Elio Clemente Agostoni  6 , Simone Vidale  1
Affiliations
Review

Mothership versus Drip-and-Ship Model for Mechanical Thrombectomy in Acute Stroke: A Systematic Review and Meta-Analysis for Clinical and Radiological Outcomes

Michele Romoli et al. J Stroke. 2020 Sep.

Abstract

Background and purpose: Substantial uncertainty exists on the benefit of organizational paradigms in stroke networks. Here we systematically reviewed and meta-analyzed data from studies comparing functional outcome between the mothership (MS) and the drip and ship (DS) models.

Methods: The meta-analysis protocol was registered international prospective register of systematic reviews (PROSPERO) and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, and Cochrane Central databases were searched for randomized-controlled clinical trials (RCTs), retrospective and prospective studies comparing MS versus DS. Primary endpoints were functional independence at 90 days (modified Rankin Scale <3) and successful recanalization (Thrombolysis in Cerebral Infarction Scale [TICI] >2a); secondary endpoints were 3-month mortality and symptomatic intracranial haemorrhage (sICH). Odds ratios for endpoints were pooled using the random effects model and were compared between the two organizational models.

Results: Overall, 18 studies (n=7,017) were included in quantitative synthesis. MS paradigm was superior to DS model for functional independence (odds ratio, 1.34; 95% confidence interval, 1.16 to 1.55; I2=30%). Meta-regression analysis revealed association between onset-to-needle time and good functional outcome, with longer onset-to-needle time being detrimental. Similar rates of recanalization, sICH and mortality at 90 days were documented between MS and DS.

Conclusions: Patients with acute ischemic stroke eligible for reperfusion strategies might benefit more from MS paradigm as compared to DS. RCTs are needed to further refine best management taking into account logistics, facilities and resources.

Keywords: Drip and ship; Endovascular procedures; Mothership; Stroke; Thrombectomy.

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Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow-chart for selection of studies included in the meta-analysis.
Figure 2.
Figure 2.
Forest plot showing the association of organizational paradigms with functional independence (modified Rankin Scale 0–2) at 3 months. M-H, Mantel-Haenszel; CI, confidence interval.
Figure 3.
Figure 3.
Forest plot showing the association of organizational paradigms with functional independence (modified Rankin Scale 0–2) at 3 months in subgroup of patients treated with bridging therapy (combination of intravenous thrombolysis and endovascular thrombectomy). M-H, Mantel-Haenszel; CI, confidence interval.
See this image and copyright information in PMC

References

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