ABSTRACT
PURPOSE: Stroke patients are excluded from expeditious thrombectomy in regions lacking neurointerventional specialists. An audiovisual online streaming system was tested, allowing a neurointerventional specialist located at a neurovascular center to supervise and instruct a thrombectomy performed at a distant hospital without being physically present (remote streaming support [RESS]). METHODS: In total, 36 thrombectomy procedures were performed on a Mentice endovascular simulator by six radiologists not specialized in neurointerventions. Each radiologist was challenged with six different endovascular simulation scenarios under alternating conventional local support (specialist inside the room [LOS]) and RESS, which was performed using an advanced live streaming platform. RESULTS: Both support modes led to a median of 2 attempts (interquartile range [IQR] 2.0-2.0 each) until successful recanalization. There was no statistically significant difference in time from first catheter insertion to recanalization between LOS (median 24.9â¯min, IQR 21.0-31.5â¯min) and RESS (23.9â¯min, IQR 21.7-28.7â¯min, pâ¯= 0.89). The percentage of thrombi covered by the stent-retriever and average speed when retrieving the stent-retriever (3.7â¯mm/s, IQR 3.25-5.35â¯mm/s vs. 3.6â¯mm/sec, IQR 2.5-4.7) were similar in both groups. Fluoroscopy time did not differ (19.0â¯min, IQR 16.9-23.5â¯min vs. 19.9â¯min, IQR 15.9-23.5â¯min) with a trend towards increased median amounts of contrast medium used under RESS (62.9â¯ml vs. 43.1â¯ml; pâ¯= 0.055). CONCLUSION: This study confirmed the feasibility of RESS for thrombectomy procedures in a simulated environment. This serves as basis for future studies planned to analyze the effectiveness of RESS in a real-world environment and to test if it improves the learning curve of interventionalists with limited thrombectomy experience in remote areas.
