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Ischemic Stroke
Original research
‘Drip-and-drive’: shipping the neurointerventionalist to provide mechanical thrombectomy in primary stroke centers
  1. Caspar Brekenfeld1,
  2. Einar Goebell1,
  3. Holger Schmidt2,3,
  4. Henning Henningsen4,
  5. Christoffer Kraemer4,
  6. Jörg Tebben2,
  7. Fabian Flottmann1,
  8. Götz Thomalla5,
  9. Jens Fiehler1
  1. 1 Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  2. 2 Neurology, Elbe-Klinikum Stade, Stade, Germany
  3. 3 Department of Neurology, University Medical Center, Göttingen, Germany
  4. 4 Department of Neurology, Klinikum Lüneburg, Lüneburg, Germany
  5. 5 Department of Neurology, Head and Neurocenter, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Caspar Brekenfeld, Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg 20246, Germany; c.brekenfeld{at}uke.de

Abstract

Background To satisfy the increasing demand of mechanical thrombectomy (MT) for acute ischemic stroke treatment, new organizational concepts for patient care are required. This study evaluates time intervals of acute stroke management in two stroke care models, including one based on transportation of the interventionalist from a comprehensive stroke center (CSC) to treat patients in two primary stroke centers (PSC). We hypothesized that time intervals were not inferior for the ‘drip-and-drive’ concept compared with the traditional ‘drip-and-ship’ concept.

Methods Patients treated with MT at the PSC (‘drip-and-drive’, ‘D+D group’) were compared with patients transferred from PSC to CSC for MT (‘drip-and-ship’, ‘D+S group’) with regard to time delays. Time intervals assessed were: symptom onset to initial CT, to angiography, and to recanalization; time from initial CT to telephone call activation, to arrival, and to angiography; and time from telephone call activation to arrival and from arrival to angiography.

Results 42 patients were treated at the PSC after transfer of the interventionalist, and 32 patients were transferred to the CSC for MT. The groups did not differ with regard to median Onset–CT and CT–Phone times. Significant differences between the groups were found for the primary outcome measure CT–Arrival time (‘D+D group’: median 121 (IQR 108–134) min vs 181 (157–219) min for the ‘D+S group’; P<0.001). Time difference between the groups increased to more than 2 hours for median CT–Angio times (median 123 (IQR 93–147) min vs 252 (228–275) min; P<0.001).

Conclusion Time intervals for the ‘D+D group’ were not inferior to those of the ‘D+S group’. Moreover, under certain conditions, the ‘drip-and-drive’ concept might even be superior.

  • thrombectomy
  • stroke
  • political

https://doi.org/10.1136/neurintsurg-2017-013634

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    Footnotes

    • Contributors CB, HS, HH, and JF made substantial contributions to the conception and design of the work. Data acquisition was performed by CB, EG, CK, JT, and FF. CB and FF performed the data analysis. Interpretation of the data was done by CB, EG, HS, HH, GT, and JF. CB and JF drafted the manuscript and all of the other authors revised it critically for important intellectual content. All authors approved the final version to be published. They agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the manuscript are appropriately investigated and resolved.

    • Competing interests None declared.

    • Ethics approval The study was approved by the ethics committee of the Medical Association of the City of Hamburg.

    • Provenance and peer review Not commissioned; externally peer reviewed.