Wang Chun-Min, Lin Che-Wei, Chang Yu-Ming, Tzeng Ray-Chang, Wu Ming-Hsiu, Vong Si-Chon, Chen Tsang-Shan, Wu Shang-Te, Tsai Yu-Tai, Fang Yi-Ting, Yang Chuang-Chou, Su Yu-Hsiang, Huang Meng-Hua, Wu Mu-Han, Chu Feng-Yuan, Huang Yen-Chu, Lin Kuan-Hung, Chang Che-Chao, Lin Sheng-Hsiang, Sung Pi-Shan
Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan.
J Neurointerv Surg. 2025 Aug 28. doi: 10.1136/jnis-2025-023872.
While endovascular thrombectomy (EVT) has revolutionized the treatment of acute large vessel occlusions, the appropriate patient transfer paradigm remains controversial. This study compares outcomes of three transfer models in a stroke network: mothership (MS), traditional drip-and-ship (DS), and an integrated DS model using a novel transfer system (TS).
We implemented a novel TS to streamline communication and coordination between primary and comprehensive stroke centers. We analyzed 1063 patients with suspected large vessel occlusion across three groups: MS (n=814), conventional DS without TS (DS TS (-), n=185), and DS with TS (DS TS (+), n=64). Primary outcomes included treatment time metrics, EVT rates, and functional outcomes.
DS TS (+) showed improved time metrics, with onset-to-CT angiography (CTA) times comparable to MS (232 vs 255.5 min) and significantly faster than DS TS (-) (305 min). It also achieved the highest rates of both intravenous thrombolysis (51.56%) and EVT (48.44%). Among EVT patients, the DS TS (+) group had the shortest door-to-puncture time (98.0 min vs MS 132.0 min and DS TS (-) 127.0 min, P<0.001) and a shorter onset-to-puncture time compared with the DS TS (-) group. DS TS (+) also showed a promising trend towards superior functional outcomes at 3 months (modified Rankin Scale score 0-2: 54.84% vs MS 39.10% vs DS TS (-) 36.36%).
This study shows that an integrated DS model using a structured TS can achieve outcomes comparable to the MS model. Enhancing transfer efficiency through innovative solutions tailored to the regional infrastructure may serve as a viable alternative alongside the MS model.
虽然血管内血栓切除术（EVT）彻底改变了急性大血管闭塞的治疗方式，但合适的患者转运模式仍存在争议。本研究比较了卒中网络中三种转运模式的结果：母舰模式（MS）、传统的静脉滴注转运模式（DS）以及使用新型转运系统（TS）的综合DS模式。
我们实施了一种新型TS，以简化初级和综合卒中中心之间的沟通与协调。我们分析了1063例疑似大血管闭塞的患者，分为三组：MS组（n = 814）、未使用TS的传统DS组（DS TS（-），n = 185）和使用TS的DS组（DS TS（+），n = 64）。主要结局包括治疗时间指标、EVT率和功能结局。
DS TS（+）组的时间指标有所改善，发病至CT血管造影（CTA）时间与MS组相当（232分钟对255.5分钟），且明显快于DS TS（-）组（305分钟）。它还实现了最高的静脉溶栓率（51.56%）和EVT率（48.44%）。在接受EVT的患者中，DS TS（+）组的门到穿刺时间最短（98.0分钟对MS组的132.0分钟和DS TS（-）组的127.0分钟，P<0.001），与DS TS（-）组相比，发病至穿刺时间也更短。DS TS（+）组在3个月时还显示出功能结局更佳的有前景趋势（改良Rankin量表评分0 - 2：54.84%对MS组的39.10%对DS TS（-）组的36.36%）。
本研究表明，使用结构化TS的综合DS模式可以取得与MS模式相当的结果。通过针对区域基础设施量身定制的创新解决方案提高转运效率，可能成为MS模式之外的可行替代方案。
