Impact of the drip-and-ship model on the treatment of acute ischemic stroke in relation to distance from the thrombectomy center

Background The drip-and-ship model is a common practice for patients with ischemic stroke due to large-vessel occlusion (LVO), providing initial diagnostics and thrombolysis in transition to endovascular treatment (EVT). However, hospital transfer results in treatment delays for patients requiring EVT, potentially affecting outcomes. We sought to explore the association between distance from residence and time intervals to admission with clinical outcomes after EVT. Methods In this monocentric retrospective cohort study, patients with acute ischemic stroke due to LVO who underwent EVT at Frankfurt University Hospital between 2017 and 2023 were analyzed. Patients were grouped according to direct-to-center (DC) or drip-and-ship (DS) admission. Clinical outcome parameters included patient global disability after 90 days as measured by the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) score improvements analyzed in relation to geographical distance and time metrics. A subgroup analysis based on the distance from residence in 10 km intervals was added. Results A total of 334 patients were included. Of these, 41.9% were DC admissions and 58.1% DS were admissions. Distances from home to center were shorter for DC patients (11.1 km vs. 36.4 km, p < 0.001), resulting in significantly shorter times from symptom onset to admission (−114 min; 71 min vs. 185 min; p < 0.001) and to flow restoration (−88 min; 213 min vs. 301 min; p < 0.001). After 90 days, no significant differences in clinical outcomes between DC and DS were observed. However, DC patients living closer than 10 km to the center were more likely to achieve an mRS score