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Case series
Initiation of mechanical thrombectomy in an insular setting with helicopter transfer: a 2-year experience from the first, complete, tertiary stroke center in the Caribbean
  1. Quentin Bourgeois-Beauvais1,
  2. Doriane Sellin1,
  3. Isaure Arnaud1,
  4. Celia Tuttle2,
  5. Anne Landais3,
  6. Annie Lannuzel3,4,
  7. Aissatou Signate1,
  8. Jerome Berge5,
  9. Christina Iosif2,6
    1. 1Neurology, University Hospital of Martinique, Fort de France, France
    2. 2Diagnostic and Interventional Radiology, University Hospital of Martinique, Fort de France, France
    3. 3Neurology, University Hospital of Guadeloupe, Point a Pitre, France
    4. 4School of Medicine, Universite des Antilles UFR Medecine Hyacinthe Bastaraud, Pointe-a-Pitre, Guadeloupe
    5. 5Neuroradiology, Centre Hospitalier Universitaire Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
    6. 6School of Medicine, Universite des Antilles UFR Medecine Hyacinthe Bastaraud, site de Martinique, Fort de France, France
    1. Correspondence to Professor Christina Iosif, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique; christina.iosif{at}


    Background This is the first cohort study of patients treated with mechanical thrombectomy (MT) for acute ischemic stroke in the French West Indies, with a mothership center and helicopter transfer.

    Objective To describe the population and to evaluate imaging, clinical, and time metric outcomes, in order to assess the feasibility and adjust the territorial organization.

    Methods In this observational study, we retrospectively analyzed our prospectively collected data of a population of consecutive patients treated with MT for anterior and posterior circulation large vessel occlusions. Primary outcome was 3-month functional independence (modified Rankin Scale score ≤2). Secondary outcomes included aerial and terrestrial times of arrival, in-hospital delays, demographics, imaging and clinical data at onset, discharge, and at 3 months. We compared the results of the mothership and drip-and-ship paradigms.

    Results Between January 2020 and December 2021, 223 patients were included (74% mothership, 26% drip-and-ship). Mean National Institutes of Health Stroke Scale (NIHSS) score of the population was 16 before MT, with significant reduction (NIHSS score 6) at discharge (9 mothership, 12 drip-and-ship, P=0.025). There was significant difference in onset-to-operation room times among the two centers (335 min mothership, 500 min drip-and-ship, P=0.004). Successful recanalization (modified Thrombolysis in Cerebral Infarction score 2b–3) was 80.3%. Functional independence at 3 months was 35%, symptomatic intracranial hemorrhage was 11%, and the complication rate was 9.4%, all without statistically significant difference between the two groups.

    Conclusion The population has distinct risk factors. MT with helicopter transfer is feasible in the French West Indies. Reduction of prehospital and in-hospital times is mandatory; evaluation of the territorial strategy is underway, to avoid over-selection of transferred patients.

    • Thrombectomy
    • Stroke
    • Blood Flow
    • Intervention

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    • Contributors All authors substantially contributed to this work, which is adherent to the appropriate ethical standards and received a statement of approval from the institution’s board. Substantial contributions to the conception or design of the work: CI and QB-B. Acquisition of data for the work: DS, ALand, IA, and CT. Analysis, or interpretation of data for the work: QB-B, ALann, AS, JB, and CI. Drafting the work or revising it critically for important intellectual content: CI, QB-B, and all authors. Final approval of the version to be published: CI and all authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Cl and all authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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    • Competing interests None declared.

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