Feasibility, Safety, and Technical Success of the Flying Intervention Team in Acute Ischemic Stroke: Comparison of Interventions in Different Primary Stroke Centers with those in a Comprehensive Stroke Center

• Published in: Clinical neuroradiology (Munich) 2023-06, Vol.33 (2), p.393-404
• Main Authors: Kettner, Alexander, Schlachetzki, Felix, Boeckh-Behrens, Tobias, Zimmer, Claus, Wunderlich, Silke, Kraus, Frank, Haberl, Roman Ludwig, Hubert, Gordian Jan, Boy, Sandra, Henninger, Julia, Friedrich, Benjamin, Maegerlein, Christian
• Format: Article
• Language: English
• Subjects: Brain Ischemia - therapy; Endovascular Procedures; Feasibility Studies; Humans; Ischemic Stroke; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosurgery; Original; Original Article; Retrospective Studies; Stroke - diagnostic imaging; Stroke - surgery; Thrombectomy - adverse effects; Thrombectomy - methods; Treatment Outcome
• ISSN: 1869-1439; 1869-1447
• DOI: 10.1007/s00062-022-01220-8

Background Prompt endovascular care of patients with ischemic stroke due to large vessel occlusion (LVO) remains a major challenge in rural regions as primary stroke centers (PSC) usually cannot provide neuro-interventional services. Objective The core content of the Flying Intervention Team (FIT) project is to perform thrombectomy on-site at a local PSC after the neuro-interventionalist has been transported via helicopter to the target hospital. An important and so far unanswered question is whether mechanical thrombectomy can be performed as safely and successfully on-site as in a specialized comprehensive stroke center (CSC). Methods Comparison of 100 FIT thrombectomies on site in 14 different PSCs with 128 control thrombectomies at 1 CSC (79 drip-and-ship, 49 mothership) performed by a single interventionalist with respect to technical-procedural success parameters, procedural times, and complications. Results There were no significant differences between the two groups in terms of technical success (95.0% successful interventions in FIT group vs. 94.5% in control group, p  = 0.60) and complications (3% major complications in FIT vs. 1.6% in control group, p  = 0.47). Regarding time from onset to groin puncture, there was no difference between FIT and the entire control group (182 vs. 183 min, p  = 0.28), but a trend in favor of FIT compared with the drip-and-ship control subgroup (182 vs. 210 min, p  = 0.096). Conclusions Airborne neuro-interventional thrombectomy service is a feasible approach for rural regions. If performed by experienced neuro-interventionalists, technical success and complication rates are comparable to treatment in a specialized neuro-interventional department.