Mothership and Drip-and-Ship Strategies in Mechanical Thrombectomy for Acute Ischemic Stroke

STUDY OBJECTIVE: The optimal out-of-hospital referral pathway for patients with acute ischemic stroke due to large vascular occlusion (AIS-LVO)-direct transport to a comprehensive center (mothership) versus initial evaluation at a local hospital followed by transfer (drip-and-ship)-remains controversial. This systematic review and meta-analysis aimed to evaluate the comparative effectiveness of mothership and drip-and-ship strategies on clinical outcomes. METHODS: We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to March 18, 2025, to identify studies comparing mothership and drip-and-ship paradigms in AIS-LVO patients treated with mechanical thrombectomy. Random-effects meta-analyses were conducted to calculate pooled odds ratios (ORs) for primary outcomes, including 90-day modified Rankin Scale (mRS) 0 to 2, 90-day mRS 0 to 3, successful recanalization, symptomatic intracranial hemorrhage, and 90-day mortality. CONCLUSION: The mothership strategy may improve 90-day mRS 0 to 2 compared with the drip-and-ship, whereas no significant differences were observed in broader functional outcomes, recanalization rates, hemorrhagic complications, or mortality.