Mothership strategy increases likelihood of achieving 90-day mRS 0 to 2 in AIS-LVO patientsMothership strategy may improve outcomes for patients with large stroke

This meta-analysis evaluated the clinical outcomes of two distinct logistical approaches for managing patients with acute ischemic stroke due to large vascular occlusion (AIS-LVO) undergoing mechanical thrombectomy: the mothership strategy and the drip-and-ship strategy. The mothership strategy involves the direct transport of patients to a comprehensive center, while the drip-and-ship strategy involves initial evaluation at a local hospital followed by transfer to a specialized center. The analysis pooled data from 42 studies involving a total population of 25,005 patients to determine the impact of these logistical pathways on functional outcomes and safety.

The primary outcome measured was the proportion of patients achieving a 90-day modified Rankin Scale (mRS) score of 0 to 2. The results indicated that the mothership strategy was associated with an increased likelihood of achieving a 90-day mRS of 0 to 2 compared to the drip-and-ship strategy, with an odds ratio (OR) of 1.15 (95% CI 1.03 to 1.29). This finding suggests a statistically significant improvement in favorable functional outcomes for patients transported directly to a comprehensive center.

Several secondary outcomes were evaluated to assess broader clinical impact and safety. For the 90-day mRS score of 0 to 3, the analysis found no significant difference between the two strategies (OR 1.12; 95% CI 0.97 to 1.29). Regarding successful recanalization, no significant difference was observed (OR 1.03; 95% CI 0.90 to 1.18). Safety metrics also showed no significant differences between the groups; the incidence of symptomatic intracranial hemorrhage was similar (OR 0.84; 95% CI 0.69 to 1.02), and the 90-day mortality rate showed no significant difference (OR 0.99; 95% CI 0.85 to 1.15).

These results provide a nuanced view of logistical impacts on stroke care. While the primary outcome suggests a benefit for the mothership strategy in achieving the highest level of functional independence (mRS 0 to 2), the lack of difference in mRS 0 to 3 suggests that the overall range of functional outcomes may not differ significantly between the two models. Furthermore, the lack of difference in recanalization rates and mortality suggests that the choice of transport model may not fundamentally alter the physiological success of the intervention or the survival of the patient.

Methodological limitations include the fact that the source data consists of observational and clinical data, which limits the ability to establish a direct causal link between the transport strategy and the observed outcomes. Additionally, the meta-analysis included studies with varying levels of heterogeneity, with I-squared values ranging from 22% to 60%. The specific quality of individual studies and detailed safety data, such as specific adverse event rates or tolerability metrics, were not reported in the summary data.

For clinical practice, these findings suggest that the mothership strategy may be a preferred logistical pathway to maximize the chances of patients achieving a high level of functional independence (mRS 0 to 2) following mechanical thrombectomy for AIS-LVO. However, because there were no significant differences in recanalization, mortality, or hemorrhage rates, the choice of strategy may be influenced by local infrastructure and resource availability. Questions remain regarding the specific factors that contribute to the improved mRS 0 to 2 outcomes in the mothership group and how these results translate across different geographic and socioeconomic settings.