Drip and ship in patients with acute ischemic stroke: a
narrative review

J 2025

Drip and ship in patients with acute ischemic stroke: a narrative review

PALAIODIMOU, Lina; Nikolaos M PAPAGEORGIOU; Eleni BAKOLA; Aikaterini THEODOROU; Michele ROMOLI et al.

Základní údaje

Originální název

Drip and ship in patients with acute ischemic stroke: a narrative review

Autoři

Vydání

THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS, LONDON, SAGE PUBLICATIONS LTD, 2025, 1756-2856

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30210 Clinical neurology

Stát vydavatele

Velká Británie a Severní Irsko

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 4.100 v roce 2024

Označené pro přenos do RIV

Ano

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

acute ischemic stroke; comprehensive stroke center; drip and ship; endovascular treatment; intravenous thrombolysis; mothership; primary stroke center; service organization

Štítky

14110127, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 23. 1. 2026 10:26, Mgr. Tereza Miškechová

Anotace

V originále

Acute ischemic stroke (AIS) is a leading cause of long-term disability and mortality worldwide, necessitating the rapid implementation of time-sensitive reperfusion therapies to improve outcomes. The "drip and ship" (DS) model, in which intravenous thrombolysis (IVT) is initiated at a primary stroke center (PSC) followed by transfer for endovascular thrombectomy (EVT) at a comprehensive stroke center, is widely adopted, particularly in regions with limited immediate EVT access. This narrative review synthesizes evidence from randomized-controlled clinical trials, large-scale observational registries, meta-analyses, and expert-consensus statements to comprehensively analyze the DS model in AIS management, compare it with the mothership (MS) paradigm, and evaluate current evidence regarding workflow optimization, pharmacologic strategies, and system-level innovations. Evidence comparing DS and MS models highlights the complexity of balancing early IVT with minimizing delays to EVT, with regional factors influencing the optimal approach. Reducing door-in-door-out times is critical within DS pathways, as prolonged interhospital transfer is associated with worse outcomes, emphasizing the need for streamlined protocols, prehospital notification, and telemedicine integration. Bridging therapy with IVT, particularly using tenecteplase, is associated with improved rates of early recanalization, supporting its continued use within DS workflows. Emerging adjunctive therapies offer potential for enhancing arterial recanalization and microcirculatory reperfusion without delaying transfer. The "drive-the-doctor" paradigm, involving the transfer of neurointerventionalists to PSCs, may further reduce onset-to-reperfusion times in geographically challenging settings. Mobile stroke units, equipped with CT imaging and telemedicine capabilities, represent an additional strategy to initiate IVT in the field while expediting triage decisions for EVT. Collectively, these advancements support the continued refinement of the DS model, emphasizing the need for structured system-level improvements to optimize timely reperfusion and functional recovery in AIS patients. Continued research is necessary to further define optimal strategies within the DS framework to ensure equitable and effective stroke care across diverse healthcare environments.

Citovat

PALAIODIMOU, Lina; Nikolaos M PAPAGEORGIOU; Eleni BAKOLA; Aikaterini THEODOROU; Michele ROMOLI; Amrou SARRAJ; Robert MIKULÍK; Nitin GOYAL; Diana Aguiar de SOUSA; Theodoros KARAPANAYIOTIDES; Ioanna KOUTROULOU; Pierre SENERS; Mira KATAN; Simona SACCO; Guillaume TURC a Georgios TSIVGOULIS. Drip and ship in patients with acute ischemic stroke: a narrative review. THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS. LONDON: SAGE PUBLICATIONS LTD, 2025, roč. 18, October 2025, s. 1-19. ISSN 1756-2856. Dostupné z: https://doi.org/10.1177/17562864251378833.

@article{2549511,
   author = {Palaiodimou, Lina and Papageorgiou, Nikolaos M and Bakola, Eleni and Theodorou, Aikaterini and Romoli, Michele and Sarraj, Amrou and Mikulík, Robert and Goyal, Nitin and Sousa, Diana Aguiar de and Karapanayiotides, Theodoros and Koutroulou, Ioanna and Seners, Pierre and Katan, Mira and Sacco, Simona and Turc, Guillaume and Tsivgoulis, Georgios},
   article_location = {LONDON},
   article_number = {October 2025},
   doi = {https://doi.org/10.1177/17562864251378833},
   keywords = {acute ischemic stroke; comprehensive stroke center; drip and ship; endovascular treatment; intravenous thrombolysis; mothership; primary stroke center; service organization},
   language = {eng},
   issn = {1756-2856},
   journal = {THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS},
   title = {Drip and ship in patients with acute ischemic stroke: a narrative review},
   url = {https://journals.sagepub.com/doi/10.1177/17562864251378833},
   volume = {18},
   year = {2025}
}

TY  - JOUR
ID  - 2549511
AU  - Palaiodimou, Lina - Papageorgiou, Nikolaos M - Bakola, Eleni - Theodorou, Aikaterini - Romoli, Michele - Sarraj, Amrou - Mikulík, Robert - Goyal, Nitin - Sousa, Diana Aguiar de - Karapanayiotides, Theodoros - Koutroulou, Ioanna - Seners, Pierre - Katan, Mira - Sacco, Simona - Turc, Guillaume - Tsivgoulis, Georgios
PY  - 2025
TI  - Drip and ship in patients with acute ischemic stroke: a narrative review
JF  - THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS
VL  - 18
IS  - October 2025
SP  - 1-19
EP  - 1-19
PB  - SAGE PUBLICATIONS LTD
SN  - 17562856
KW  - acute ischemic stroke
KW  - comprehensive stroke center
KW  - drip and ship
KW  - endovascular treatment
KW  - intravenous thrombolysis
KW  - mothership
KW  - primary stroke center
KW  - service organization
UR  - https://journals.sagepub.com/doi/10.1177/17562864251378833
N2  - Acute ischemic stroke (AIS) is a leading cause of long-term disability and mortality worldwide, necessitating the rapid implementation of time-sensitive reperfusion therapies to improve outcomes. The "drip and ship" (DS) model, in which intravenous thrombolysis (IVT) is initiated at a primary stroke center (PSC) followed by transfer for endovascular thrombectomy (EVT) at a comprehensive stroke center, is widely adopted, particularly in regions with limited immediate EVT access. This narrative review synthesizes evidence from randomized-controlled clinical trials, large-scale observational registries, meta-analyses, and expert-consensus statements to comprehensively analyze the DS model in AIS management, compare it with the mothership (MS) paradigm, and evaluate current evidence regarding workflow optimization, pharmacologic strategies, and system-level innovations. Evidence comparing DS and MS models highlights the complexity of balancing early IVT with minimizing delays to EVT, with regional factors influencing the optimal approach. Reducing door-in-door-out times is critical within DS pathways, as prolonged interhospital transfer is associated with worse outcomes, emphasizing the need for streamlined protocols, prehospital notification, and telemedicine integration. Bridging therapy with IVT, particularly using tenecteplase, is associated with improved rates of early recanalization, supporting its continued use within DS workflows. Emerging adjunctive therapies offer potential for enhancing arterial recanalization and microcirculatory reperfusion without delaying transfer. The "drive-the-doctor" paradigm, involving the transfer of neurointerventionalists to PSCs, may further reduce onset-to-reperfusion times in geographically challenging settings. Mobile stroke units, equipped with CT imaging and telemedicine capabilities, represent an additional strategy to initiate IVT in the field while expediting triage decisions for EVT. Collectively, these advancements support the continued refinement of the DS model, emphasizing the need for structured system-level improvements to optimize timely reperfusion and functional recovery in AIS patients. Continued research is necessary to further define optimal strategies within the DS framework to ensure equitable and effective stroke care across diverse healthcare environments.
ER  -

PALAIODIMOU, Lina; Nikolaos M PAPAGEORGIOU; Eleni BAKOLA; Aikaterini THEODOROU; Michele ROMOLI; Amrou SARRAJ; Robert MIKULÍK; Nitin GOYAL; Diana Aguiar de SOUSA; Theodoros KARAPANAYIOTIDES; Ioanna KOUTROULOU; Pierre SENERS; Mira KATAN; Simona SACCO; Guillaume TURC a Georgios TSIVGOULIS. Drip and ship in patients with acute ischemic stroke: a narrative review. \textit{THERAPEUTIC ADVANCES IN NEUROLOGICAL DISORDERS}. LONDON: SAGE PUBLICATIONS LTD, 2025, roč.~18, October 2025, s.~1-19. ISSN~1756-2856. Dostupné z: https://doi.org/10.1177/17562864251378833.

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