{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:45:09Z","timestamp":1782992709584,"version":"3.54.5"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large vessel occlusion. Whether the mothership model or the drip\u2010and\u2010ship model provides superior outcomes remains unclear. This systematic review and meta\u2010analysis aimed to compare functional and safety outcomes between these 2 models and assess the impact of onset\u2010to\u2010groin puncture delay on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We conducted a systematic review and meta\u2010analysis following Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines, registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD420251034209). We searched PubMed, EMBASE, and Cochrane CENTRAL up to March 9, 2025. We included randomized trials, cohort studies enrolling patients with anterior circulation large vessel occlusion treated with mechanical thrombectomy. The primary outcome was 90\u2010day functional independence (modified Rankin Scale score, 0\u20132). Secondary outcomes included excellent outcome (modified Rankin Scale score 0\u20131), successful recanalization, symptomatic intracranial hemorrhage, any intracranial hemorrhage, and 90\u2010day mortality. Risk of bias was assessed using Risk of Bias in Non\u2010randomized Studies of Interventions and Risk of Bias 2.0 tools. Meta\u2010regression was performed to evaluate the effect of onset\u2010to\u2010groin puncture time differences on outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Nineteen studies (16\u2009485 patients) were included. The mothership model and drip\u2010and\u2010ship model showed no significant difference in achieving 90\u2010day functional independence (odds ratio, 1.12 [95% CI, 0.94\u20131.32]). Meta\u2010regression showed that longer delays to thrombectomy in the drip\u2010and\u2010ship model significantly reduced the odds of functional independence (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). A onset\u2010to\u2010groin time delay of approximately 43 minutes between the two models of care was identified as the threshold beyond which the mothership model conferred superior outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Direct transport to a thrombectomy\u2010capable center should be prioritized when secondary transfer is expected to delay treatment, as functional outcomes worsen significantly beyond this threshold.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044364","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T11:33:38Z","timestamp":1771587218000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Mothership Versus Drip\u2010and\u2010Ship Models in Acute Stroke Care: A Time\u2010Sensitive Meta\u2010Analysis"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4349-3322","authenticated-orcid":false,"given":"Lucio","family":"D\u2019Anna","sequence":"first","affiliation":[{"name":"Charing Cross Hospital, Imperial College London NHS Healthcare Trust","place":["London, United Kingdom"]},{"name":"Imperial College London","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1328-3620","authenticated-orcid":false,"given":"Lorenzo","family":"Barba","sequence":"additional","affiliation":[{"name":"Martin\u2010Luther\u2010University Halle\u2010Wittenberg","place":["Halle (Saale), Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0631-8506","authenticated-orcid":false,"given":"Samir","family":"Abu\u2010Rumeileh","sequence":"additional","affiliation":[{"name":"Martin\u2010Luther\u2010University Halle\u2010Wittenberg","place":["Halle (Saale), Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3011-7405","authenticated-orcid":false,"given":"Edoardo","family":"Pirera","sequence":"additional","affiliation":[{"name":"Maternal\u2010Infant","place":["Palermo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diletta","family":"Rosin","sequence":"additional","affiliation":[{"name":"University of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4708-4316","authenticated-orcid":false,"given":"Fedra","family":"Kuris","sequence":"additional","affiliation":[{"name":"University of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8719-2441","authenticated-orcid":false,"given":"Alessandra","family":"Burini","sequence":"additional","affiliation":[{"name":"University of Udine","place":["Udine, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1725-1175","authenticated-orcid":false,"given":"Francesco","family":"Bax","sequence":"additional","affiliation":[{"name":"University of Udine","place":["Udine, Italy"]},{"name":"Massachusetts General Hospital and Harvard Medical School","place":["Boston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4273-4267","authenticated-orcid":false,"given":"Markus","family":"Otto","sequence":"additional","affiliation":[{"name":"Martin\u2010Luther\u2010University Halle\u2010Wittenberg","place":["Halle (Saale), 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