Drip ‘n Ship Versus Mothership for Endovascular Treatment

• DOI: 10.1161/strokeaha.116.015321
• Publication Date: 2017-01-19T02:55:45Z
• Authors: Matthew S.W. Milne; Jessalyn K. Holod...; Michael D. Hill; Anders Nygren; Chao Qiu; Mayank Goyal; Noreen Kamal
• Keywords: Time Factors; Endovascular Procedures; Brain Ischemia; 3. Good health; Stroke; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Fibrinolytic Agents; Tissue Plasminogen Activator; Humans; Female; Thrombolytic Therapy; Aged

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 acute ischemic stroke. The role nonendovascular-capable Primary (PSC) that can offer thrombolysis with alteplase but not unclear. A key question whether average benefit greater early at closest PSC before transportation CSC (Drip ‘n Ship) bypass direct transport (Mothership). Ideal options were mapped based on location their CSCs PSCs. Methods— Probability models developed from ESCAPE trial’s (Endovascular Treatment Small Core Anterior Circulation Proximal Occlusion With Emphasis Minimizing CT Recanalization Times) decay curves extracted Get Guidelines curve. time on-scene, needle-to-door-out PSC, door-to-needle CSC, door-to-reperfusion assumed constant 25, 20, 30, 115 minutes, respectively. Emergency medical services times calculated using Google’s Distance Matrix Application Programming Interface interfaced MATLAB’s Mapping Toolbox create map visualizations. Results— Maps generated multiple onset-to-first response PSCs 60, 90. These figures demonstrate option yields better modeled outcome in specific regions. probability good shown. Conclusions— Drip Ship demonstrates a close proximity remains significant only when able achieve ≤30 minutes also efficient.