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. 2023 Jun;33(2):393-404.
doi: 10.1007/s00062-022-01220-8. Epub 2022 Nov 2.

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

Alexander Kettner  1 , Felix Schlachetzki  2 , Tobias Boeckh-Behrens  1 , Claus Zimmer  1 , Silke Wunderlich  3 , Frank Kraus  4 , Roman Ludwig Haberl  4 , Gordian Jan Hubert  4 , Sandra Boy  5 , Julia Henninger  6 , Benjamin Friedrich  7 , Christian Maegerlein  8
Affiliations

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

Alexander Kettner et al. Clin Neuroradiol. 2023 Jun.

Abstract

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.

Keywords: FIT; Flying interventionalist; Helicopter; Helistroke; Mechanical thrombectomy.

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Conflict of interest statement

G.J. Hubert, C. Maegerlein, B. Friedrich, F. Kraus received funding from the Bavarian health insurances for setup of the project. C. Maegerlein, B. Friedrich received two rolling suitcases for transportation of thrombectomy materials to PSC by Penumbra Inc., Alameda, CA, USA. G. Hubert received a grant from the Bavarian Ministry of Health and the Björn Steiger Foundation. A. Kettner, F. Schlachetzki, T. Boeckh-Behrens, C. Zimmer, S. Wunderlich, R.L. Haberl, S. Boy and J. Henninger and declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic illustration of the three main care concepts in endovascular stroke therapy in rural areas. In the drip and ship model, the patient is first taken to the regional stroke unit where, if indicated, IVT is performed. In the case of an LVO, the patient is secondarily transferred to a CSC for thrombectomy. In the mothership model, the ambulance by-passes the regional stroke unit and drives directly to a CSC where all diagnostic and therapeutic options are available. In the Flying Intervention Team concepts, the patient receives IVT if indicated and is immediately prepared for MT on site in the event of an LVO. At the same time, the interventionalist is transported to the PSC to perform the endovascular procedure there
Fig. 2
Fig. 2
Illustration of the coverage area of the FIT service. Teleneurological headquarters were positioned in Munich and Regensburg. Interventional headquarters and place of departure for the FIT helicopter was Munich exclusively. Red dots represent PSCs with neurological departments, yellow dots represent PSCs with only internal medical departments. White dots represent CSC with neuro-interventional institutions that received patients for MT from PSCs (not within the scope of this study)
Fig. 3
Fig. 3
Illustration of the materials and the transport containers used in the project. Figure a shows the rod case with the long catheters. Figure b shows the wheeled suitcase opened with the materials and the aspiration pump inside. Figure c displays the materials that are stocked on site and have already been prepared by the local staff. Figure d presents the same case as shown in b loaded in the helicopter’s cargo hold
See this image and copyright information in PMC

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