Drip-and-Ship versus Mothership Model in Acute Ischemic Stroke: A Meta-Analysis Stratified by Stroke System Integration.

BACKGROUND

Although the mothership transport (MS) model (direct transport to a thrombectomy-capable center) has been associated with improved functional outcomes compared with the drip-and-ship (DS) model (initial transport to a local center for thrombolysis followed by transfer) in acute ischemic stroke, the influence of stroke system integration on these outcomes remains unclear.

OBJECTIVE

To compare clinical outcomes between DS and MS models and assess the impact of system integration.

METHODS

This systematic review and meta-analysis involved a search of PubMed, Embase, and Cochrane (from inception up to March 2026) for studies comparing DS and MS in acute ischemic stroke. Inclusion required reporting of 90-day functional outcomes. Outcomes included the modified Rankin Scale (mRS), recanalization, hemorrhage, and mortality. Data were pooled using random-effects models, with analyses stratified by stroke system integration level.

RESULTS

Thirty-seven studies encompassing 21,644 patients (mean age 70.1 (DS) and 70.7 (MS)) were included. MS was associated with significantly shorter symptom onset-to-recanalization times (251.0 ± 111.0 vs. 347.0 ± 128.0 minutes). MS patients had higher rates of functional independence (mRS, 0-2; OR, 0.78; 95% CI: 0.70-0.86) and lower rates of poor outcomes (mRS, 3-6; OR, 1.30; 95% CI: 1.17-1.45). No significant differences were found for successful recanalization, rates of symptomatic intracranial hemorrhage, or mortality. Stratified analyses showed no significant interaction between transport model outcomes and the level of system integration.

CONCLUSIONS

The MS model provides shorter treatment times and superior functional outcomes compared to DS, regardless of stroke system integration level. Rates of recanalization, hemorrhage, and mortality were similar between models.