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

Clin Neuroradiol. 2021 Mar;31(1):181-187. doi: 10.1007/s00062-019-00870-5. Epub 2019 Dec 20.


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.

Keywords: Revascularization; Stroke; Stroke management; Telemedicine; Vascular intervention.

MeSH terms

  • Brain Ischemia* / diagnostic imaging
  • Brain Ischemia* / surgery
  • Endovascular Procedures*
  • Humans
  • Retrospective Studies
  • Stents
  • Stroke* / diagnostic imaging
  • Stroke* / surgery
  • Thrombectomy
  • Treatment Outcome