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Case Reports
. 2021 Feb;13(2):e1.
doi: 10.1136/neurintsurg-2020-016722.rep. Epub 2020 Oct 20.

Republished: Interhospital teleproctoring of endovascular intracranial aneurysm treatment using a dedicated live-streaming technology: first experiences during the COVID-19 pandemic

Matthias Bechstein  1 , Samer Elsheikh  2 , Fritz Wodarg  3 , Christian A Taschner  2 , Uta Hanning  4 , Jan-Hendrik Buhk  5 , Rosalie McDonough  4 , Einar Goebell  4 , Jens Fiehler  4 , Maxim Bester  4
Affiliations
Case Reports

Republished: Interhospital teleproctoring of endovascular intracranial aneurysm treatment using a dedicated live-streaming technology: first experiences during the COVID-19 pandemic

Matthias Bechstein et al. J Neurointerv Surg. 2021 Feb.

Abstract

This is a report of the first three cases of endovascular aneurysm treatment that were proctored by a remote interventionalist using a novel high-resolution low-latency streaming technology. The proctor was located in a neurovascular centre and supported the treating interventional teams in two distant cities (up to 800 km/500 miles apart). All aneurysms were treated using the Woven EndoBridge (WEB) embolisation system, either electively or following subarachnoid haemorrhage. On-site proctoring was not possible due to travel restrictions during the COVID-19 pandemic. WEB placement was feasible in all cases. Good rapport between proctors and treating physicians was reported, enabled by the high-resolution image transmission and uninterrupted feedback/discussion via audiostream. No clinical complications were encountered. Short-term follow-up revealed adequate occlusion of all treated aneurysms. The employed streaming technology provided effective remote proctoring during complex aneurysm cases, including the management of technical complications.

Keywords: aneurysm; angiography; intervention; subarachnoid.

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Conflict of interest statement

Competing interests: JF: research support: German Ministry of Science and Education, German Ministry of Economy and Innovation, German Research Foundation, European Union, Hamburgische Investitions- und Förderbank, Medtronic, Microvention, Route92, Stryker; consultant for Acandis, Bayer, Boehringer Ingelheim, Cerenovus, Evasc Neurovascular, MD Clinicals, Medtronic, Microvention, Penumbra, Phenox, Stryker and Transverse Medical; stock holder: Tegus Medical.

Figures

Figure 1
Figure 1
Live telestream set-up for remote proctoring. (A) Stand-alone rig with the installed high-definition web camera (red box). (B) Screenshot of the device set-up as seen by the proctor from his computer. The proctor can change the field of view, focus and zoom with dedicated buttons on the streaming platform. (C) Screenshot of the proctor’s selected field of view with visibility of the angiography monitors (sample image taken during a thrombectomy).
Figure 2
Figure 2
Digital subtraction angiography images of the treated aneurysms in each of the three patients: (A–C) before treatment and (D–F) after treatment.
See this image and copyright information in PMC

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