Comparison of Mothership Versus Drip-and-Ship Models for Endovascular Treatment of Basilar Artery Occlusion in the London Metropolitan Area

Background To date it is uncertain whether the drip-and-ship (DS) model (transport to the nearest primary stroke centers) or the mothership (MS) model (direct transportation to the comprehensive stroke center) is the best prehospital stroke system of care to deliver endovascular thrombectomy in patients with basilar artery occlusion. In the present analysis, we aim to investigate the impact of MS versus DS model in patients with basilar artery occlusion treated with endovascular thrombectomy in the London metropolitan area.Methods This is a multicenter observational, investigator-initiated, retrospective study comparing outcomes (functional independence, defined as modified Rankin scale scores of 0 through 2, the rate of successful reperfusion, and the rate of complications postprocedure) in DS versus MS stroke patients with basilar artery occlusion admitted in 5 thrombectomy capable centers in London (United Kingdom).Results Of 113 patients, 38 (33.6%) patients were MS and 75 (66.4%) were DS. Between the 2 groups we did not observe statistically significant differences for most of the clinical characteristics. There was a significant difference regarding the rate of functional independence at 3 months between the MS and DS groups, respectively 47.4% versus 36% (P = 0.047). Rates of complications postprocedure and successful recanalization did not differ between the 2 groups. Multivariable regression analysis demonstrated that MS model was an independent predictor of functional independence at 90 days (odds ratio [OR] 1.17; [95% CI, 1.11-1.26]; P = 0.003 and independent negative predictor of postoperative complications (OR, 0.39; [95% CI, 0.16-0.98]; P = 0.045).Conclusion Our study showed that MS model was a predictor of functional independence at 3 months and reduced risk of postoperative complications post-endovascular thrombectomy in patients with basilar artery occlusion in a metropolitan area.