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  • Comparison of Three Stroke Delivery Protocols: Efficacy of Mobile Neurointerventional Teams

    Final Number:

    Daniel Wei; Thomas Oxley; Dominic Anthony Nistal; Justin Robert Mascitelli MD; Natalie Wilson; Laura Stein; John Liang; Lena Turkheimer; Claire Schwegel NP; Ahmed J Awad MD; Hazem Shoirah; Christopher P. Kellner MD; Reade De Leacy; Stephan A. Mayer MD; Stanley Tuhrim; Joshua B. Bederson MD; J Mocco MD, MS; Johanna Fifi MD

    Study Design:

    Subject Category:
    Ischemic Stroke

    Meeting: AANS/CNS Cerebrovascular Section 2017 Annual Meeting

    Introduction: Neurointervention for ischemic stroke is a complex treatment with multiple models of service delivery. The ‘mothership’ model involves direct EMS transport to a Comprehensive Stroke Center (CSC) for IV-tPA and neurointervention. The ‘drip-and-ship’ model involves transport to a nearby peripheral hospital for IV-tPA before transfer to a CSC for neurointervention. A concern about mothership is that bypassing peripheral hospitals may delay time to IV-tPA, whereas drip-and-ship may delay time to endovascular treatment. In this abstract, we describe a ‘trip-and-treat’ model that may minimize both these risks. In trip-and-treat, a mobile neurointerventional team (MNT) is shared between a CSC and several primary stroke centers with interventional capacity (PSCI). The MNT travels to the PSCI in the event of a stroke. Patients who present to the PSCI therefore remain at the PSCI for treatment by the MNT instead of being transferred to a CSC. Our aim was to assess the efficacy of mothership, drip-and-ship, and trip-and-treat stroke models.

    Methods: We performed a retrospective and prospective analysis on 114 stroke patients who received endovascular treatment for acute stroke at a Manhattan-based hospital system. Of these patients, 12% (n=14) were treated in mothership, 54% (n=61) in drip-and-ship, and 34% (n=39) in trip-and-treat. Symptom-to-puncture was defined as time from discovery of stroke symptoms to arterial puncture. Change in NIHSS was defined from hospital admission to discharge.

    Results: Symptom-to-puncture time was 210±72 minutes for mothership, 292±86 minutes for drip-and-ship, and 211±69 minutes for trip-and-treat. Mothership and trip-and-treat both had faster treatment times than drip-and-ship (P=0.0019, P<0.0001). There was no difference in treatment time between mothership and trip-and-treat (P=0.9978). There was no significant difference in time to IV-tPA between the three protocols (P=0.7328). Change in NIHSS was -10.4 for trip-and-treat and -2.4 for drip-and-ship (P=0.0179).

    Conclusions: Trip-and-treat is superior to drip-and-ship for endovascular treatment times and clinical outcomes.

    Patient Care: This research describes a service delivery model for ischemic stroke that may decrease time to treatment and increase access to endovascular care through use of mobile neurointervention teams.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of mobile neurointervention teams in provision of endovascular treatment for acute stroke, 2) Discuss, in small groups, three different models for neurointervention service delivery, 3) Identify an effective treatment for ischemic stroke with large vessel occlusion.


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