Two roads to the clot: Which stroke model really wins?

Having two methodologically different approaches to STROKE, one might expect significantly divergent results, and the absence of such differences can seem counterintuitive. We will present two articles that address this question from various perspectives to explore the intricacies of STROKE management.

When facing a patient with ischemic stroke and suspected large vessel occlusion (LVO), every minute makes a difference. Mechanical thrombectomy has become the treatment with the greatest current clinical evidence, but we are first confronted with the dichotomy of management models (Mothership vs. Drip and Ship).

It may surprise us that two such contrasting models show results that are not so far apart — though, as with everything, there are nuances. Let us review what Lieschke et al. (1) (2026) tell us in Frontiers in Neurology.

We examined 334 patients treated with thrombectomy (Mothership: 41.9%, Drip and Ship: 58.1%) at the University Hospital of Frankfurt between 2017 and 2023. The results come as no surprise: patients managed under the Mothership model lived closer to the center (median 11.1 km vs. 36.4 km), arrived earlier (71 vs. 185 minutes from symptom onset), and recanalization was achieved sooner (213 vs. 301 minutes).

Despite this, the modified Rankin Scale (mRS) showed no significant difference between the two groups. One relevant subgroup, however – patients living less than 10 km from the thrombectomy center – did show a higher probability of achieving a good functional outcome (OR 2.995; 95% CI 1.296–7.318).

The second article, D’Anna et al. (2) (Journal of the American Heart Association, 2026), carries out a meta-analysis of 19 international studies. Replicating the previous finding, no significant difference was found between the two management models for mRS at 90 days.

Regardless, it identifies one clear delimiting variable: when the time difference between the two management models exceeds 43 minutes, the Mothership model is the better option.

The absence of significance in comparative studies does not imply clinical indifference. Context, geographic distribution, and many other factors that may be relevant to STROKE management must all be taken into account.

Author(s): David Ramirez Moro, Biomedical Research Institute of Malaga and the Nanomedicine Platform

Links: 

Lieschke F, Mueller G, Keil F, Bohmann FO, Grefkes C and Schaefer JH (2026) Impact of the drip-and-ship model on the treatment of acute ischemic stroke in relation to distance from the thrombectomy center. Front. Neurol. 16:1708262. doi: 10.3389/fneur.2025.1708262

D’Anna L, Barba L, Abu-Rumeileh S, Pirera E, Rosin D, Kuris F, Burini A, Bax F, Otto M, Valente M, Gigli GL, Banerjee S, Sacco S, Toni D, Calci M, Chiandetti R, Regattin L, Piscaglia MG, Nguyen TN, Lobotesis K, Bhalla A, Zhang L, Spooner O, Chandratheva A, Cumberbatch G, Simister R, Foschi M, Merlino G (2026) Mothership Versus Drip-and-Ship Models in Acute Stroke Care: A Time-Sensitive Meta-Analysis. J Am Heart Assoc. 15:e044364. doi: 10.1161/JAHA.125.044364

Keywords: #StrokeManagement #MechanicalThrombectomy #MothershipModel #DripAndShip #LargeVesselOcclusion