%0 Journal Article
%T Systematic review of organizational models for intra
%A Alfonso Ciccone
%A Eivind Berge
%A Urs Fischer
%J International Journal of Stroke
%@ 1747-4949
%D 2019
%R 10.1177/1747493018806157
%X Intra-arterial treatment of acute ischemic stroke requires changes to acute stroke services since most hospitals do not have on-site intra-arterial treatment facilities. To identify models for delivery of intra-arterial treatment and to compare process performance and clinical and radiological outcomes of the different models. We systematically searched the literature and contacted experts in the field. We performed a qualitative synthesis to identify models, and a quantitative review and meta-analysis of clinical and radiological outcomes under different organizational models. The searches retrieved 148 publications, of which 27 were used for the identification and description of models, and 9 for the comparison of the different models. We identified four main models: the mother-ship, drip-and ship, mobile interventionist, and mobile stroke unit models. There were no randomized-controlled trials of the different models, but non-randomized comparisons were possible using data from 8 observational studies and 1 randomized-controlled trial of intra-arterial therapy, of a total of 4127 patients. Comparison between the mother-ship and drip-and-ship models showed no difference in survival (OR 0.81; 95% CI 0.63¨C1.03), favorable functional outcome (OR 0.96; 95% CI 0.73¨C1.25), or arterial patency (OR 0.89; 95% CI 0.73¨C1.08). Different organizational models exist for intra-arterial treatment of acute ischemic stroke, but there is insufficient evidence to recommend a particular, universal model. Until one model can be shown to be superior, the choice of model should depend on local factors and patient characteristics
%K Emergency medical services
%K patient transfer
%K ischemic stroke
%K thrombectomy
%K endovascular treatment
%K thrombolysis
%K review
%U https://journals.sagepub.com/doi/full/10.1177/1747493018806157