Two Paradigms of Care Delivery for Acute Large-Artery Stroke

As of 2015, intravenous thrombolysis (IVT) within 4.5 hours followed by mechanical thrombectomy (MT) within the first 6 hours is considered standard treatment for large-artery anterior-circulation strokes. Because most hospitals lack MT capabilities, two paradigms of care delivery are under consideration to achieve effective implementation in the real-world setting: (1) IVT at the nearest hospital followed by immediate transfer to a center capable of MT (drip-and-ship paradigm) and (2) direct referral to a center capable of MT for combined IVT/MT (mothership paradigm). The drip-and-ship approach may result in earlier IVT at the expense of delayed MT, while the mothership approach may result in delayed IVT followed by earlier MT.

Using prospe…