Clinical Neuroradiology

, Volume 28, Issue 4, pp 473–480 | Cite as

Stroke Transfer and its Organizational Paradigm

Review of Organizational Paradigms and the Impact on Outcome
  • Lili Détraz
  • Marielle Ernst
  • Romain BourcierEmail author
Review Article


Since the clinical recognition of endovascular therapy (EVT) for stroke treatment is recent (2015), some organizational issues, such as the “drip and ship (DS) versus mothership (MS)” access to EVT remain unanswered. There is growing pressure to guarantee immediate access to EVT with limited human resources and infrastructures. As results from prospective studies are missing, a review of the existing literature dealing with clinical retrospective studies was carried out. Most of the studies did not report a significant difference with respect to the adverse effects for patients treated by EVT according to the organizational paradigm of care. Several studies did not report a significant difference concerning the 3 months functional outcomes regarding the organizational paradigm. Only two studies built theoretical models of the best outcomes and observed a superiority of the DS only if the door to needle time was less than 30 min. Waiting for the results of ongoing randomized controlled trials, this review of articles presenting patients treated with either MS or DS provides an overview but does not emphasize a superiority of a given paradigm; however, it highlights the inequalities of access to EVT according to the organization of care in different areas.


Mother ship Drip and ship Organization Endovascular treatment Systematic review 


Conflict of interest

L. Détraz, M. Ernst and R. Bourcier declare that they have no competing interests.


  1. 1.
    Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723–31.CrossRefGoogle Scholar
  2. 2.
    Haute Autorité de Santé (HAS). Rapport d’évaluation technologique: Thrombectomie des artères intracrâniennes par voie endovasculaire. 2016.Google Scholar
  3. 3.
    Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion (RACECAT). Available from:, Last update March 6, 2017
  4. 4.
    Park MS, Lee JS, Park TH, Cho YJ, Hong KS, Park JM et al. Characteristics of the drip-and-ship paradigm for patients with acute ischemic stroke in South Korea. J Stroke Cerebrovasc Dis. 2016;25:2678–87.CrossRefGoogle Scholar
  5. 5.
    Park MS, Yoon W, Kim JT, Choi KH, Kang SH, Kim BC et al. Drip, ship, and on-demand endovascular therapy for acute ischemic stroke. PLoS One. 2016;11:e150668.CrossRefGoogle Scholar
  6. 6.
    Hiyama N, Yoshimura S, Shirakawa M, Uchida K, Oki Y, Shindo S et al. Safety and effectiveness of drip, ship, and retrieve paradigm for acute ischemic stroke: a single center experience. Neurol Med Chir (Tokyo). 2016;56:731.CrossRefGoogle Scholar
  7. 7.
    Gerschenfeld G, Muresan IP, Blanc R, Obadia M, Abrivard M, Piotin M, Alamowitch S. Two paradigms for endovascular thrombectomy after intravenous thrombolysis for acute ischemic stroke. JAMA Neurol. 2017;74:549–56.CrossRefGoogle Scholar
  8. 8.
    Weber R, Reimann G, Weimar C, Winkler A, Berger K, Nordmeyer H et al. Neurovascular Net Ruhr. Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy. Ther Adv Neurol Disord. 2016;9:79–84.CrossRefGoogle Scholar
  9. 9.
    Mohamad NF, Hastrup S, Rasmussen M, Andersen MS, Johnsen SP, Andersen G et al. Bypassing primary stroke centre reduces delay and improves outcomes for patients with large vessel occlusion. Eur Stroke J. 2016;1:85–92.CrossRefGoogle Scholar
  10. 10.
    Milne MS, Holodinsky JK, Hill MD, Nygren A, Qiu C, Goyal M et al. Drip’n ship versus mothership for endovascular treatment: modeling the best transportation options for optimal outcomes. Stroke. 2017;48:791–4.CrossRefGoogle Scholar
  11. 11.
    Holodinsky JK, Williamson TS, Kamal N, Mayank D, Hill MD, Goyal M. Drip and ship versus direct to comprehensive stroke center. Stroke. 2017;48:233–8.CrossRefGoogle Scholar
  12. 12.
    Cappelen-Smith C, Cordato D, Calic Z, Cheung A, Wenderoth J. Endovascular thrombectomy for acute ischaemic stroke: a real-world experience. Intern Med J. 2016;46:1038–43.CrossRefGoogle Scholar
  13. 13.
    Menon BK, Sajobi TT, Zhang Y, Rempel JL, Shuaib A, Thornton J et al. 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 trial. Circulation. 2016;133:2279–86.CrossRefGoogle Scholar
  14. 14.
    Sablot D, Gaillard N, Smadja P, Bonnec J‑M, Bonafe A. Thrombectomy accessibility after transfer from a primary stroke center: analysis of a three-year prospective registry. Int J Stroke. 2017;12:519–23.CrossRefGoogle Scholar
  15. 15.
    Pérez de la Ossa N, Abilleira S, Dorado L, Urra X, Ribó M, Cardona P et al. Catalan Stroke Code and Reperfusion Consortium. Access to endovascular treatment in remote areas: analysis of the Reperfusion Treatment Registry of Catalonia. Stroke. 2016;47:1381–4.CrossRefGoogle Scholar
  16. 16.
    Tsai JP, Mlynash M, Christensen S, Kemp S, Kim S, Mishra NK et al. CRISP Investigators. Time from imaging to endovascular reperfusion predicts outcome in acute stroke. Stroke. 2018;49:952–7.CrossRefGoogle Scholar
  17. 17.
    Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378:11–21.CrossRefGoogle Scholar
  18. 18.
    Abilleira S, Ribera A, Cardona P, Rubiera M, López-Cancio E, Amaro S et al. Outcomes after direct thrombectomy or combined intravenous and endovascular treatment are not different. Stroke. 2017;48:375–8.CrossRefGoogle Scholar
  19. 19.
    Nogueira RG, Silva GS, Lima FO, Yeh YC, Fleming C, Branco D et al. The FAST-ED app: a smartphone platform for the field triage of patients with stroke. Stroke. 2017;48:1278–84.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional NeuroradiologyGuillaume et René Laennec University HospitalNantesFrance
  2. 2.Radiology DepartmentUniversity of Hamburg-EppendorfHamburgGermany

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