The RACECAT trial aimed to evaluate whether direct transfer to an Endovascular Stroke Center, compared to transfer to the nearest Local Stroke Center, results in better outcomes in the distribution of modified Rankin Scale (mRS) scores at 90 days in patients with acute ischemic stroke and clinically suspected Large Vessel Occlusion (LVO) identified by Emergency Medical Services (EMS).
The RACECAT study was a prospective, multicenter, cluster-randomized trial conducted throughout Catalonia. The primary outcome was assessed by blinded evaluators. The study included patients with suspected acute stroke due to LVO, identified by EMS using the RACE scale. A RACE score of 5 or higher (indicating a high suspicion of LVO) was the main inclusion criterion. Two transportation strategies were compared:
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Drip-and-ship: transfer to the nearest local stroke center, and
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Mothership: direct transfer to an endovascular stroke center.
A total of 1,401 patients were enrolled. The study showed that in non-urban areas, direct transfer to an endovascular center resulted in a higher rate of thrombectomy and shorter time to treatment. However, there were no significant differences in 90-day neurological outcomes between patients transported to a local stroke center versus a thrombectomy-capable center. These results should be interpreted in the context of the study’s demonstration of a highly coordinated inter-hospital transfer system within the drip-and-ship model.
For more details, refer to the study publication in JAMA.
Subsequently, secondary analyses derived from the RACECAT study suggest that the optimal route depends on patient characteristics, the type of stroke, and the logistical conditions of the centers.
Thus, the Drip-and-Ship model may be preferable in patients with a final diagnosis of cerebral hemorrhage (JAMA Neurol).
In contrast, the Mothership model (direct transfer to a center with thrombectomy capacity) may promote recovery in patients seen beyond 3 hours after symptom onset (with fewer options for intravenous thrombolytic therapy), or when coordination of transfers and in-hospital times are not optimal, as occurs during nighttime hours.
