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Training and Supervision of Thrombectomy by Remote Live Streaming Support (RESS)

Randomized Comparison Using Simulated Stroke Interventions

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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 24.9 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.

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Acknowledgements

The authors thank Drs. Jawed Nawabi, Anna Kyselyova, Julia Götz, Teresa Nawka and Silvia Münchmeyer-Bechstein for assistance with the experiments.

Funding

Medtronic plc (Dublin, Ireland) kindly provided hardware free-of-charge during the preparation phase of this study. The Mentice simulator was kindly provided by the manufacturer (Mentice AB, Gothenburg, Sweden) free-of-charge for the time of the study. The funders had no influence on study design, protocol, data analysis, data interpretation and manuscript writing.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Matthias Bechstein, Jan-Hendrik Buhk, Andreas Maximilian Frölich, Gabriel Broocks, Uta Hanning, Jens Fiehler & Einar Goebell

  2. TEGUS Medical GmbH, Stresemannstraße 375, Unit 11, 22761, Hamburg, Germany

    Martin Erler, Milan Anđelković & Dragan Debeljak

Authors
  1. Matthias Bechstein
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  2. Jan-Hendrik Buhk
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  3. Andreas Maximilian Frölich
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  4. Gabriel Broocks
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  5. Uta Hanning
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  6. Martin Erler
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  7. Milan Anđelković
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  8. Dragan Debeljak
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  9. Jens Fiehler
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  10. Einar Goebell
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Corresponding author

Correspondence to Matthias Bechstein.

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Conflict of interest

M. Bechstein received research support from the German Research Foundation (DFG). J.-H. Buhk is consultant for Acandis, Cerenovus, Medtronic, MicroVention, Stryker and Route 92. A.M. Frölich received speaker’s fees from Penumbra Inc. J. Fiehler received research support from the German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Philips, Stryker. He is consultant for Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Medtronic, Microvention, Penumbra and Stryker. He holds shares in Tegus Medical. G. Broocks, U. Hanning, M. Erler, M. Andjelkovic, D. Debeljak and E. Goebell declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Bechstein, M., Buhk, JH., Frölich, A.M. et al. Training and Supervision of Thrombectomy by Remote Live Streaming Support (RESS). Clin Neuroradiol 31, 181–187 (2021). https://doi.org/10.1007/s00062-019-00870-5

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  • DOI: https://doi.org/10.1007/s00062-019-00870-5

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