Times to endovascular treatment following two triage models

Introduction Debate is ongoing regarding the best service model for achieving a prompt recanalization in LVO ischemic stroke with an indication for thrombectomy. We aim to assess differences between two of the existing models within our region. Methods We work in a cluster of three public hospitals (one hub and two spokes) forming a single functional neurology service in Madrid (Spain). Upon a LVO case out of regular hours, the interventional neuroradiologist drives to the hub hospital following the drive-the-doctor paradigm (DD). For any of the spokes, the patient is transferred to the nearest endovascular-capable hospital (drip-and-ship—DS) following the Madrid Stroke Plan. We compared times to endovascular procedures between cases managed under each model. Results Thirty-eight patients in the period April 2014–March 2021 meet the inclusion criteria (DD 27; DS 11). While baseline characteristics are comparable between groups, we observed a notable difference in the time delays favoring those managed under the DD model; with differences between median times of 105 min for hospital arrival–groin puncture (DD 140 [110–181]; DS 245 [222–310], p 0.0004); 122 min for CT–groin puncture (DD 100 [85–144]; DS 222 [200–255], p = 0.0001); and 98 min for hospital arrival–recanalization (DD 180 [140–209]; DS 278 [241–360], p = 0.0014). No differences were observed for NIHSS or mRS on discharge. Conclusions Compared to the drip-and-ship, the drive-the-doctor triage model for patients with LVO ischemic stroke in primary centers seems to guarantee a shorter time to the start of the endovascular procedure and to recanalization in our region.