Stroke Transfer and its Organizational Paradigm : Review of Organizational Paradigms and the Impact on Outcome.

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.