Raquin M, Lambert C, Paris P, Bourgois N, Clavelou P, Moisset X, Ferrier A
CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
Rev Neurol (Paris). 2025 Jan-Feb;181(1-2):67-78. doi: 10.1016/j.neurol.2024.06.007. Epub 2024 Jul 29.
The availability of mechanical thrombectomy (MT) is limited. Thus, there are two paradigms for patients living closer to a primary stroke center (PSC) than a comprehensive stroke center (CSC) capable of MT: "Mothership" (direct referral to a CSC) and "Drip-and-Ship" (referral to a PSC for imaging and thrombolysis and transfer to a CSC for thrombectomy or monitoring). We aimed to compare the prognosis of patients at three months between the two paradigms in a rural area.
From September 2019 to March 2021, we prospectively included patients living closer to a PSC than the one CSC, regardless of the type of stroke or reperfusion treatment. The proportion of patients with a good functional outcome (Rankin≤2) at three months was compared between the two initial orientations for all patients and for subgroups: patients with ischemic stroke and patients treated by MT.
Among the 206 patients included, 103 were admitted directly to the CSC (82.5% had an ischemic stroke and 24.3% a MT) and 103 initially admitted to a PSC and then transferred to the CSC (100% had an ischemic stroke and 52.4% a MT). The proportion of patients with a good outcome was comparable between the two groups (54.5% vs. 43.7%, P=0.22). Among the 79 patients who underwent MT, the prognosis at three months was better in the Mothership group (49.3% vs. 15.3%, P=0.01).
The functional prognosis is comparable between Mothership and Drip-and-Ship paradigms in our setting, despite a trend towards a better prognosis for the Mothership. As has been shown in urban settings, the mothership paradigm also leads to a better prognosis for patients treated with MT in a rural setting.
机械取栓术（MT）的可及性有限。因此，对于居住在距离能够进行MT的综合卒中中心（CSC）比初级卒中中心（PSC）更近的患者，存在两种模式：“母舰模式”（直接转诊至CSC）和“溶栓转运模式”（转诊至PSC进行影像学检查和溶栓，然后转至CSC进行取栓或监测）。我们旨在比较农村地区这两种模式下患者三个月时的预后情况。
2019年9月至2021年3月，我们前瞻性纳入了居住在距离一个CSC比PSC更近的患者，无论其卒中类型或再灌注治疗方式如何。比较了两组患者在所有患者以及亚组（缺血性卒中患者和接受MT治疗的患者）中三个月时功能预后良好（Rankin评分≤2）的患者比例。
在纳入的206例患者中，103例直接入住CSC（82.5%为缺血性卒中，24.3%接受了MT），103例最初入住PSC，然后转至CSC（100%为缺血性卒中，52.4%接受了MT）。两组患者良好预后的比例相当（54.5%对43.7%，P = 0.22）。在接受MT的79例患者中，母舰模式组三个月时的预后更好（49.3%对15.3%，P = 0.01）。
在我们的研究环境中，母舰模式和溶栓转运模式的功能预后相当，尽管母舰模式有预后更好的趋势。正如在城市环境中所显示的那样，母舰模式在农村环境中也能使接受MT治疗的患者获得更好的预后。
