Drip and ship and mothership models of mechanical thrombectomy result in similar outcomes in acute ischemic stroke of the anterior circulation.

BACKGROUND: Stroke therapy has been transformed in recent years due to the availability of thrombolysis and mechanical thrombectomy (MT). Whether transferring the patient directly to a comprehensive stroke center (CSC, mothership model) is better than taking them to a primary stroke center (PSC) and then to a CSC for MT (drip and ship) is unclear but has important implications. We compared the performance of both models in a district of the Basque country, Spain. METHODS: This is a retrospective analysis of prospectively collected data of all acute ischemic stroke patients consecutively admitted to the Neurology Department of two institutions and eligible for MT over a 36-month period with anterior circulation large vessel occlusion (LVO). One center applied the mothership model and the other the drip-and-ship. The two models were compared in terms of mortality and functional status assessed by modified Rankin (mRS) scale at 90 days. As a surrogate of the effectiveness of the two models, all times pertinent to stroke therapy were recorded. RESULTS: A total of 187 patients were evaluated subjected to MT with the drip-and-ship model and 188 with mothership, with a median NIHSS of 15. Prior to MT, 17% of the drip-and-ship patients received thrombolysis and 26% in the mothership. Neither mortality rate nor mRS showed statistically significant differences 90 days after stroke. The time lapse from stroke to MT was optimal in both models; albeit being 10 minutes longer in the drip-and-ship model, it had no impact on patients' outcomes. CONCLUSIONS: Drip-and-ship and mothership models can provide optimal and similar results in acute stroke patients in terms of mortality and functional status at 90 days. Their coexistence may alleviate the burden of CSC thus facilitating the access of more stroke patients to advanced therapies in an equitable manner.

Isolated and reversible lesions of the corpus callosum: a distinct entity.

The Reversible Splenial Lesion Syndrome represents a distinct clinicoradiological syndrome, associated with several disorders, including infection, high altitude cerebral edema, antiepileptic drug withdrawal, and severe metabolic disturbances (hypoglycemia and hypernatremia). Clinical presentation is nonspecific, most frequently as an encephalopathy or encephalitis. Outcome is favorable in most patients unless there is a severe underlying disorder. Magnetic resonance imaging findings are restricted to the splenium and consist of a nonenhancing oval lesion, hyperintense on T2-weighted images, including FLAIR. Findings on diffusion-weighted imaging are consistent with cytotoxic edema except for high-altitude cerebral edema, where vasogenic edema is present. Resolution after weeks or months is the rule.