Drip ‘n Ship Versus Mothership for Endovascular Treatment
Top Cited Papers
- 1 March 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 48 (3), 791-794
- https://doi.org/10.1161/strokeaha.116.015321
Abstract
Background and Purpose—: There is uncertainty regarding the best way for patients outside of endovascular-capable or Comprehensive Stroke Centers (CSC) to access endovascular treatment for acute ischemic stroke. The role of the nonendovascular-capable Primary Stroke Centers (PSC) that can offer thrombolysis with alteplase but not endovascular treatment is unclear. A key question is whether average benefit is greater with early thrombolysis at the closest PSC before transportation to the CSC (Drip ‘n Ship) or with PSC bypass and direct transport to the CSC (Mothership). Ideal transportation options were mapped based on the location of their endovascular-capable CSCs and nonendovascular-capable PSCs. Methods—: Probability models for endovascular treatment were developed from the ESCAPE trial’s (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) decay curves and for alteplase treatment were extracted from the Get With The Guidelines decay curve. The time on-scene, needle-to-door-out time at the PSC, door-to-needle time at the CSC, and door-to-reperfusion time were assumed constant at 25, 20, 30, and 115 minutes, respectively. Emergency medical services transportation times were calculated using Google’s Distance Matrix Application Programming Interface interfaced with MATLAB’s Mapping Toolbox to create map visualizations. Results—: Maps were generated for multiple onset-to-first medical response times and door-to-needle times at the PSCs of 30, 60, and 90. These figures demonstrate the transportation option that yields the better modeled outcome in specific regions. The probability of good outcome is shown. Conclusions—: Drip ‘n Ship demonstrates that a PSC that is in close proximity to a CSC remains significant only when the PSC is able to achieve a door-to-needle time of ≤30 minutes when the CSC is also efficient.Keywords
This publication has 12 references indexed in Scilit:
- Suspected Large Vessel OcclusionStroke, 2016
- Analysis of Workflow and Time to Treatment on Thrombectomy Outcome in the Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke (ESCAPE) Randomized, Controlled TrialCirculation, 2016
- Future directions of acute ischaemic stroke therapyThe Lancet Neurology, 2015
- Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in StrokeThe New England Journal of Medicine, 2015
- Endovascular Clot Retrieval TherapyStroke, 2015
- Randomized Assessment of Rapid Endovascular Treatment of Ischemic StrokeThe New England Journal of Medicine, 2015
- Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging SelectionThe New England Journal of Medicine, 2015
- A Randomized Trial of Intraarterial Treatment for Acute Ischemic StrokeThe New England Journal of Medicine, 2015
- Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trialsThe Lancet, 2014
- Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trialThe Lancet Neurology, 2014