Key result
Mothership transfer improves 90-day functional independence ~17% over drip-and-ship despite higher hemorrhage risk.
Why the study?
Optimal transport routing for acute ischemic stroke between mothership and drip-and-ship models remains uncertain, especially with extended treatment time windows.
Does the mothership model improve functional outcomes compared to the drip-and-ship model in patients with acute ischemic stroke?
Meta-Analysis (n=10,059)
Yes
Does the mothership model improve functional outcomes compared to the drip-and-ship model in patients with acute ischemic stroke?
The mothership model improves 90-day functional independence in acute ischemic stroke but is associated with an elevated risk of symptomatic intracranial hemorrhage compared to the drip-and-ship model.
Background Acute ischemic stroke requires urgent treatment, yet geographic disparities in specialized care necessitate two transport strategies: direct transfer to comprehensive stroke centers (mothership, MS) versus initial treatment at primary centers followed by transfer (drip-and-ship, DS). Optimal routing remains uncertain, particularly with extended treatment time windows. Methods Systematic review and meta-analysis adhering to PRISMA/MOOSE guidelines. Literature search of PubMed, Embase, and Cochrane through October 17, 2025, identified comparative studies evaluating MS versus DS in acute stroke. Outcomes included 90-day functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH), reperfusion success (TICI 2b-3), and 90 days mortality. Random-effects models pooled odds ratios. Results Twenty-eight observational studies (10,059 patients) were included; no randomized controlled trial met the final inclusion criteria. MS demonstrated superior functional independence (OR 0.83, 95%CI 0.73–0.95, p = 0.008), with stronger effects in prospective studies. No mortality difference was observed (OR 1.05, 95%CI 0.92–1.21). MS significantly increased hemorrhage risk (OR 1.41, 95%CI 1.12–1.77, p = 0.003). Reperfusion rates did not differ between models. Conclusion The mothership model improves functional outcomes but elevates hemorrhage risk without mortality benefit. Direct transport to comprehensive stroke centers is recommended when geographically feasible, accompanied by intensive post-procedural monitoring. Rural settings require tailored, context-specific strategies.
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Zhang et al. (2026) conducted a meta-analysis in Acute ischemic stroke (n=10,059). Mothership model (direct transfer to comprehensive stroke centers) vs. Drip-and-ship model (initial treatment at primary centers followed by transfer) was evaluated on 90-day functional independence (mRS 0-2) (OR 0.83, 95% CI 0.73-0.95, p=0.008). The mothership model demonstrated superior 90-day functional independence compared to drip-and-ship (OR 0.83; 95% CI 0.73-0.95; p=0.008), but increased hemorrhage risk.
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