Background and purpose It is increasingly recognized that time is one of the key determinants in acute stroke outcome when applying interventional stroke therapy. 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 patient site to improve time to “procedure.” Applying this same principle to interventional stroke may be a valid paradigm.
Methods Previous logistical deliberation with hospital and Medevac companies was performed to provide rationale and funding for helicopter transfer of a neurointerventionalist to an in-network hospital with on-site angiographic suite and interventional radiologists. An appropriate patient with large vessel occlusion and NIH stroke scale greater than 8 was identified. Magnetic Resonance Imaging was performed per NIH Stroke Program protocols, then the Medevac transport system was activated and the intervention was performed. Times were collected during the case and assessed for time efficiency.
Results Proof of concept case was identified and sent for imaging. Medevac was consulted at 12:13 pm 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 pm. Groin puncture occurred at 13:07 pm, intervention was completed at 13:41 pm. 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 spoke and hub design of stroke systems of care.
Disclosures A. El Mekabaty: None. F. Hui: None. V. Urrutia: None. J. Lynch: None. Z. Naidarashvili: None.
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