Abstract Background and aims Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Whether the mothership model or the drip-and-ship model provides superior outcomes remains unclear. This systematic review and meta-analysis aimed to compare functional, procedural, and safety outcomes between these two models, and assess the impact of onset-to-groin puncture delay on outcomes. Methods We conducted a systematic review and meta-analysis following PRISMA guidelines, registered in PROSPERO (CRD420251034209). We searched PubMed, EMBASE, and Cochrane CENTRAL up to March 9, 2025. We included randomized trials and cohort studies enrolling patients with anterior circulation LVO treated with MT. The primary outcome was 90-day functional independence (modified Rankin Scale mRS 0–2). Secondary outcomes included excellent outcome (mRS 0–1), successful recanalization, symptomatic intracranial hemorrhage, any intracranial hemorrhage, and 90-day mortality. Meta-regression was performed to evaluate the effect of onset-to-groin puncture time differences on outcomes. Results Nineteen studies (16,485 patients) were included. Meta-regression showed that longer delays to thrombectomy in the drip-and-ship model significantly reduced the odds of functional independence (p0.001). A delay of approximately 43 minutes was identified as the threshold beyond which the mothership model conferred superior outcomes (figure ). No significant differences were found in rates of excellent outcome, successful reperfusion, symptomatic hemorrhage, any intracranial hemorrhage, or mortality. Conclusions When the drip-and-ship model introduces delays greater than 43 minutes, direct transport to comprehensive stroke centers (mothership) should be preferred to maximize clinical benefit. Conflict of interest nothing to disclose Figure 1 - belongs to Results
D'anna et al. (Fri,) studied this question.