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Original research
Helistroke: neurointerventionalist helicopter transport for interventional stroke treatment: proof of concept and rationale
  1. Ferdinand K Hui1,
  2. Amgad El Mekabaty1,
  3. Jacky Schultz2,
  4. Kelvin Hong1,
  5. Karen Horton1,
  6. Victor Urrutia3,
  7. Imama Naqvi4,
  8. Shawn Brast5,
  9. John K Lynch4,
  10. Zurab Nadareishvili4,6
  1. 1Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  2. 2President's Office, Suburban Hospital, Bethesda, Maryland, USA
  3. 3Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
  4. 4Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
  5. 5Johns Hopkins Lifeline, Johns Hopkins Hospital, Baltimore, Maryland, USA
  6. 6Suburban Hospital NIH Stroke Center and Johns Hopkins Community Physicians, Bethesda, Maryland, USA
  1. Correspondence to Dr Ferdinand K Hui, Department of Radiology, Johns Hopkins Hospital, 1800 Orleans St, Bloomberg Bldg, 7th Floor, Baltimore, MD 7218, USA; fhui2{at}


Background and purpose It is increasingly recognized that time is one of the key determinants in acute stroke outcome when interventional stroke therapy is applied. With increasing device efficacy and understanding of imaging triage options, reducing pre-treatment time loss may be a critical component of improving interventional stroke outcomes for the population at large. Time sensitive procedures such as organ harvest have transported physicians to the patient site to improve time to procedure. Applying this same principle to interventional stroke management may be a valid paradigm.

Methods Previous logistical deliberation with hospital and Medevac companies was carried out to provide the rationale and funding for helicopter transfer of a neurointerventionalist to an in-network hospital with an on-site angiographic suite. An appropriate patient with large vessel occlusion and an NIH Stroke Scale score >8 was identified. MRI was performed, then the Medevac transport system was activated and the intervention was carried out. Times were collected during the case and assessed for time efficiency.

Results The proof of concept case was identified and Medevac was consulted at 12:13 after verifying that no in-house emergencies would prevent physician departure. Weather clearance was obtained and stroke intervention confirmed as a go at 12:24. Groin puncture occurred at 13:07 and the intervention was completed at 13:41. The total time from decision-to-treat to groin puncture was 43 min and groin closure was completed at 77 min from decision-to-treat.

Conclusions This proof of concept case is presented for logistical, financial and use-case analysis. As it is a first case, times can likely be improved. We assert that this model may be another option in the spoke-and-hub design of stroke systems of care.

  • Angiography
  • Economics
  • Intervention
  • Stroke

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  • Twitter Follow Shawn Brast @shawnbrast and Zurab Nadareishvili @Stroke

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.