Training and Supervision of Thrombectomy by Remote Live Streaming Support (RESS) Randomized Comparison Using Simulated Stroke Interventions

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 24.9min, IQR 21.0-31.5min) and RESS (23.9min, IQR 21.7-28.7min, p= 0.89). The percentage of thrombi covered by the stent-retriever and average speed when retrieving the stent-retriever (3.7mm/s, IQR 3.25-5.35mm/s vs. 3.6mm/sec, IQR 2.5-4.7) were similar in both groups. Fluoroscopy time did not differ (19.0min, IQR 16.9-23.5min vs. 19.9min, IQR 15.9-23.5min) with a trend towards increased median amounts of contrast medium used under RESS (62.9ml vs. 43.1ml; 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.

Automated summary

The study tested the feasibility of a remote streaming support (RESS) system for thrombectomy procedures in a simulated environment. Results showed no significant differences in various parameters between procedures conducted with this system and conventional local support, but the RESS group may have used more contrast medium.