Management of acute ischemic stroke. Bridging vs. mothership

Clinical issue: Acute ischemic stroke remains one of the most common causes of death in Germany and affects around 16,000 people every year. With the begin of using of i.v. lysis therapy in the mid-1990s and endovascular thrombectomy (after publication of randomized studies) in 2015, these two procedures represent the two most important pillars in acute therapy. In the absence of neuroradiology centers with endovascular treatment options, there are two principles for triaging of stroke patients-the drip-and-ship or mothership model. The question repeatedly arises as to whether and exactly when bridging i.v. lysis therapy should be used. Results: The S2 guideline for the treatment of acute stroke offers an evidence-based treatment decision for treating physicians and has been extended until 2026, with the exception of a few updates, due to its proven effectiveness. Conclusion: Every stroke patient should receive i.v. lysis therapy, taking into account the onset of neurological symptoms and possible contraindications, regardless of the planned triaging principle.