ArticleEuropean stroke journal2018
Drip and ship versus direct to endovascular thrombectomy: The impact of treatment times on transport decision-making.
Article in European stroke journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Latest evidence on transfer efficiency and patient outcomes in mothership versus drip-and-ship models for acute stroke management: a systematic review and meta-analysis.Frontiers in neurology · 2026Pooled it
- Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature.Journal of neurology · 2021Pooled it
- Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke.European journal of neurology · 2021Trial
- Beyond Time Is Brain: The Time, Tissue, and Systems Framework for Acute Stroke.Journal of central nervous system disease · 2026Article
- A Bayesian conditional probability simulation framework for pre-hospital stroke transport decisions in the tenecteplase era: decision boundaries, global sensitivity, and stochastic dominance.Frontiers in neurology · 2026Article
- Direct-to-Angio Without Any Repeat Neuroimaging for Planned Endovascular Therapy in Patients Transferred From Remote Primary Stroke Centers: A Propensity-Matched Study.Stroke (Hoboken, N.J.) · 2025Article
- Direct mechanical thrombectomy versus bridging therapy in acute ischemic stroke: A systematic review and meta-analysis of randomized clinical trials.World neurosurgery: X · 2024Review
- Determinants of infarct progression and perfusion core growth in transferred LVO patients from remote regions.Frontiers in neurology · 2024Article
- Prehospital Detection of Large Vessel Occlusion Stroke With EEG.Neurology · 2023Article
- Geographical Requirements for the Applicability of the Results of the RACECAT Study to Other Stroke Networks.Journal of the American Heart Association · 2023Article
- Effect of time delay in inter-hospital transfer on outcomes of endovascular treatment of acute ischemic stroke.Frontiers in neurology · 2023Article
- Acute Middle Cerebral Artery Occlusion Detection Using Mobile Non-Imaging Brain Perfusion Ultrasound-First Case.Journal of clinical medicine · 2022Article
- A mobile battery-powered brain perfusion ultrasound (BPU) device designed for prehospital stroke diagnosis: correlation to perfusion MRI in healthy volunteers.Neurological research and practice · 2022Article
- European Stroke Organisation (ESO) guidelines on mobile stroke units for prehospital stroke management.European stroke journal · 2022Article
- Potential accuracy of prehospital NIHSS-based triage for selection of candidates for acute endovascular stroke therapy.Journal of the American College of Emergency Physicians open · 2021Article
- Hub-and-spoke model for thrombectomy service in UK NHS practice.Clinical medicine (London, England) · 2021Article
- Pre- and Interhospital Workflow Times for Patients With Large Vessel Occlusion Stroke Transferred for Endovasvular Thrombectomy.Frontiers in neurology · 2021Article
- Air vs. Road Decision for Endovascular Clot Retrieval in a Rural Telestroke Network.Frontiers in neurology · 2020Article
- Only a Minority of Thrombectomy Candidates Are Admitted During Night Shift: A Rationale for Diurnal Stroke Care Planning.Frontiers in neurology · 2020Article
- A Standardized Aspiration-First Approach for Thrombectomy to Increase Speed and Improve Recanalization Rates.AJNR. American journal of neuroradiology · 2019Article
Corrections and comments
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Authors and funding
22 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn ischaemic stroke care, fast reperfusion is essential for disability free survival. It is unknown if bypassing thrombolysis centres in favour of endovascular thrombectomy (mothership) outweighs transport to the nearest thrombolysis centre for alteplase and then transfer for endovascular thrombectomy (drip-and-ship). We use conditional probability modelling to determine the impact of treatment times on transport decision-making for acute ischaemic stroke. MATERIALS AND
methodsProbability of good outcome was modelled using a previously published framework, data from the Irish National Stroke Register, and an endovascular thrombectomy registry at a tertiary referral centre in Ireland. Ireland was divided into 139 regions, transport times between each region and hospital were estimated using Google's Distance Matrix Application Program Interface. Results were mapped using ArcGIS 10.3.
resultsUsing current treatment times, drip-and-ship rarely predicts best outcomes. However, if door to needle times are reduced to 30 min, drip-and-ship becomes more favourable; even more so if turnaround time (time from thrombolysis to departure for the endovascular thrombectomy centre) is also reduced. Reducing door to groin puncture times predicts better outcomes with the mothership model. DISCUSSION: This is the first case study modelling pre-hospital transport for ischaemic stroke utilising real treatment times in a defined geographic area. A moderate improvement in treatment times results in significant predicted changes to the optimisation of a national acute stroke patient transport strategy.
conclusionsModelling patient transport for system-level planning is sensitive to treatment times at both thrombolysis and thrombectomy centres and has important implications for the future planning of thrombectomy services.
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