title: Drip, Ship, and On-Demand Endovascular Therapy for Acute Ischemic Stroke.
abstract: BACKGROUND
  The "drip and ship" approach can facilitate an early initiation of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) at community hospitals. New endovascular treatment modalities, such as stent retrieval, have further improved the rate of safe and successful recanalization. We assessed the clinical outcomes of on-demand endovascular therapy in patients with AIS who were transported to a comprehensive stroke center under the "drip and ship" paradigm.
  
  
  METHODS
  This retrospective study evaluated prospectively registered patients with acute large vessel occlusions in the anterior circulation who underwent endovascular recanalization after IVT at our regional comprehensive stroke center between January 2011 and April 2014. Clinical outcomes and neuroradiological findings were compared between patients who received IVT at the center (direct visit, DV) and at a community hospital (drip and ship, DS).
  
  
  RESULTS
  Baseline characteristics such as age, initial National Institutes of Health Stroke Scale (NIHSS) score, and risk factors for stroke were similar, and most patients underwent endovascular therapy with a Solitaire stent (81.9% vs. 89.3% for DV and DS, respectively, P = 0.55). The average initial NIHSS score was 12.15 ± 4.1 (12.06 vs. 12.39 for DV and DS, respectively, P = 0.719). The proportions of long-term favorable outcomes (modified Rankin Scale score ≤ 2 at 90 days) and successful recanalization (Thrombolysis in Cerebral Ischemia score ≥ 2b) were not significantly different (P = 0.828 and 0.158, respectively). The mortality rates and occurrences of symptomatic intracerebral hemorrhage were not significantly different (P = 0.999 and 0.267, respectively).
  
  
  CONCLUSIONS
  The "drip and ship" approach with subsequent endovascular therapy is a feasible treatment concept for patients with acute large vessel occlusion in the anterior circulation that could help improve clinical outcomes in patients with AIS.
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.|Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Man-Seok
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Radiology, Chonnam National University Medical School, Gwangju, Korea.|Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Woong
authors.initials: W
authors.lastname: Yoon
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.|Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea.|Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Kang-Ho
authors.initials: KH
authors.lastname: Choi
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.|Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: B Chae
authors.initials: BC
authors.lastname: Kim
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seung-Han
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seong-Min
authors.initials: SM
authors.lastname: Choi
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.|Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Myeong-Kyu
authors.initials: MK
authors.lastname: Kim
authors.affiliation: Clinical Research Center, Asan Medical Center, Seoul, Korea.
authors.forename: Ji-Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Eun-Bin
authors.initials: EB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.|Gwangju-Jeonnam Regional Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome