Table 1. Established patient transport paradigms in acute ischemic stroke.

Transport paradigm	Description	Advantages	Disadvantages
Direct to mothership	The patient is directly transported to the nearest CSC, bypassing PSCs even if they are closer than the CSC	Since every patient gets admitted to an EVT-capable center, EVT treatment delays are minimized	Time to intravenous alteplase treatment might be longer when PSCs are bypassed Risk of overwhelming CSCs with non-LVO strokes PSCs lose their patients which can lead to loss of revenue, jobs, etc.
Drip and ship	The patient is transported to the nearest PSC for intravenous alteplase treatment and in case an LVO is present, he/she is transferred to a CSC	Time to intravenous alteplase is minimized as transport times to the PSC is usually shorter than to the nearest CSC	EVT is delayed in LVO patients since they have to be redirected from the PSC to the CSC after the LVO diagnosis has been confirmed
Flying/driving neurointerventionalist	An interventional team is mobilized from the CSC and sent to the PSC	Time to EVT is shorter in certain geographies as it is faster to transfer the interventional team than transferring the patient	High personnel costs (a whole additional neurointerventional team has to be available) Unfamiliarity of the neurointerventional team with the equipment and premises in the external hospital EVT facilities (neuroangiography suite, anesthesia, etc.) have to be available at the PSC
Mobile stroke unit	A CT-equipped specialized ambulance is dispatched to the site of the stroke and after intracranial hemorrhage has been ruled out on CT, treatment with intravenous alteplase is initiated	Intravenous alteplase can be initiated in the pre-hospital setting, which can minimize alteplase treatment delays in certain geographies	High initial outlays and maintenance costs Depending on the geography, number and location of available MSUs, the time to reach the patient can be long

EVT: endovascular treatment