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Erschienen in:
20.12.2019 | Original Article
Training and Supervision of Thrombectomy by Remote Live Streaming Support (RESS)
Randomized Comparison Using Simulated Stroke Interventions
Erschienen in: Clinical Neuroradiology | Ausgabe 1/2021
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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 24.9 min, IQR 21.0–31.5 min) and RESS (23.9 min, IQR 21.7–28.7 min, p = 0.89). The percentage of thrombi covered by the stent-retriever and average speed when retrieving the stent-retriever (3.7 mm/s, IQR 3.25–5.35 mm/s vs. 3.6 mm/sec, IQR 2.5–4.7) were similar in both groups. Fluoroscopy time did not differ (19.0 min, IQR 16.9–23.5 min vs. 19.9 min, IQR 15.9–23.5 min) with a trend towards increased median amounts of contrast medium used under RESS (62.9 ml vs. 43.1 ml; p = 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.