Abstract Body: Introduction:
Acute ischemic stroke (AIS) with large vessel occlusion (LVO) benefits from mechanical
thrombectomy (MT), but the majority of Americans require interhospital transfer for MT.
Thrombolysis at the spoke hospital with the patient transferred to the hub for MT is a model
known as “drip-and-ship.” In contrast, “mothership” patients present directly to MT capable
centers and have immediate access to MT. We sought to evaluate the effects of thrombolysis
dwell time (time for the drug to work) and drip-and-ship versus mothership status on
recanalization rates.

Methods:
Among 385 patients who received thrombolysis for AIS at our academic comprehensive stroke
center from January 1, 2023 to June 30 2024, 76 patients had LVO and repeat vessel imaging
available to evaluate for recanalization status. Thrombolysis dwell time was defined as the time
from administration of thrombolysis to repeat vascular imaging. Recanalization was defined as
complete resolution of the occlusion. Partial recanalization was defined as some recanalization
(i.e. M1 transformed into M2). Patients without vascular imaging or without repeat vessel
imaging were excluded. Data was collected on demographics, last known normal time (LKN),
National Institutes of Health Stroke Scale (NIHSS), thrombolysis administration time, and repeat
vascular imaging results.

Results:
Among 76 AIS LVO patients, the mean age was 68.8 years (range, 25.1 to 96.8), and 40
(52.6%) were women. The mean initial NIHSS was 14.7 (range, 0 to 34). Twenty-three (30%)
were mothership and 53 (69.7%) were drip-and-ship. The mean time from LKN to thrombolysis
was 2.2 hours (range, 0 to 4.9). The site of LVO occlusion was as follows: 56 (76.7%) M1, 8
(10.5%) M2s occlusions, 5 (6.6%) carotid terminus, 5 (6.6%) basilar, and 2 (2.6%) PCA
occlusions. In 69 (90.8%), repeat vascular imaging was cerebral angiogram. There were 7
(9.2%) complete recanalization, and 20 (26.2%) partial recanalization. Mothership status was
associated with lower rates of partial recanalization (8.7% vs 34%, p 0.016) and shorter mean
thrombolysis dwell time (0.9 hours vs 2.7 hours, p < 0.0001) compared to drip-and-ship status.

Conclusions:
In LVO AIS patients who receive thrombolysis, drip-and ship status is associated with higher
partial recanalization rates and longer thrombolysis drug dwell time compared to mothership
status. This may impact strategy for recruitment of sites in clinical trials.