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. 2024 Oct 29:15910199241282721.
doi: 10.1177/15910199241282721. Online ahead of print.

"Chopperlysis": The effect of helicopter transport on reperfusion and outcomes in large vessel occlusion strokes

Manisha Koneru  1   2 , Jesse M Thon  1   2 , Michael J Dubinski  1 , Ana Leticia Fornari Caprara  2 , Danielle C Brown  1 , Zixin Yi  1 , Omnea Elgendy  1 , Jiyoun Ackerman  1 , Mary Penckofer  1 , Rosa Shi  1 , Misa Fang  1 , Lucas Garfinkel  1 , Tarun Thomas  2 , Karan Patel  1 , Emma Frost  2 , Abyson Kalladanthyil  1 , Kenyon Sprankle  1 , Renato Oliveira  2 , Joshua Santucci  2 , Ahmad A Ballout  2 , James E Siegler  2   3 , Hermann C Schumacher  1   2 , Khalid A Hanafy  1   2 , Jane Khalife  1   2 , Pratit D Patel  1   2 , Daniel A Tonetti  1   2 , Ajith J Thomas  1   2 , Tudor G Jovin  1   2 , Hamza A Shaikh  1   2
Affiliations

"Chopperlysis": The effect of helicopter transport on reperfusion and outcomes in large vessel occlusion strokes

Manisha Koneru et al. Interv Neuroradiol. .

Abstract

Background: In large vessel occlusion (LVO) stroke patients transferred to a comprehensive stroke center for thrombectomy, spontaneous reperfusion may occur during transport, and anecdotally more frequently in patients transferred via helicopter than by ground. This pattern has been more often observed in conjunction with tenecteplase (TNK) treatment prior to helicopter transport. We aim to explore the "chopperlysis" effect-how helicopter transport, particularly with thrombolytics, may affect reperfusion and clinical outcomes.

Methods: A single thrombectomy capable center (TCC) registry of stroke patients was retrospectively reviewed. Included LVO patients were those who had been transferred to the TCC and received a digital subtraction angiography (DSA) upon arrival. The outcomes were rates of spontaneous reperfusion, distal clot migration, and 90-day good functional outcome. Data were summarized, and endpoints were compared between patients stratified by transport method and/or TNK treatment.

Results: Of 270 patients included, helicopter transport was associated with a higher rate of spontaneous reperfusion, particularly among patients not treated with TNK (p < 0.001). There was no significant difference in prevalence of distal clot migration between any subgroups (p > 0.37). Overall, TNK-treated patients had better functional outcomes, and this difference persisted exclusively in the helicopter-transported patients (p = 0.02).

Conclusion: Helicopter transport was associated with a higher rate of spontaneous reperfusion. There is a potentially synergistic effect between TNK administration and helicopter transport, augmenting thrombolysis and improving long-term outcomes. Further analyses in larger cohorts may expand our understanding of this "chopperlysis" effect.

Keywords: Ischemic stroke; helicopter; reperfusion; tenecteplase; thrombectomy.

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Conflict of interest statement

Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AJT has equity in Qure.ai. TGJ is a consultant for Anaconda, Route 92 Medical, Viz.Ai, FreeOx, Blockade Medical, and MeThinks. He serves in an advisory capacity for Cerenovus and Contego Medical. He has equity in Corindus. He receives research support from Medtronic and Stryker. All other authors have no disclosures to declare.

Figures

Figure 1.
Figure 1.
A patient with a left M1 middle cerebral artery segment occlusion per computed tomography angiography (A) at outside hospital was transferred via helicopter without thrombolytic administration. This patient had an occlusive clot in the same segment visualized on digital subtraction angiography upon arrival, with modified Treatment in Cerebral Infarction score 0 (B). Thrombectomy was performed, with successful reperfusion (C).
Figure 2.
Figure 2.
A patient with a right M2 middle cerebral artery segment occlusion per computed tomography angiography at outside hospital was given thrombolytics and transported via helicopter. On digital subtraction angiography upon arrival, there was full restoration of flow in the previously occluded M2 segment (A) without requiring additional interventions, and an occlusion in a frontal M4 branch of the right middle cerebral artery (B).
Figure 3.
Figure 3.
A patient with a complete occlusion in the right superior M2 middle cerebral artery segment per computed tomography angiography at outside hospital (A) was transported via helicopter without thrombolytic administration. On digital subtraction angiography upon arrival, there was evidence of partial recanalization, with slow flow through the segment but distal branch filling, with modified Treatment in Cerebral Infarction score 2B (B).
Figure 4.
Figure 4.
Schematic demonstrating possibilities for tenecteplase (TNK) treatment and transport method prior to arrival at thrombectomy capable center (TCC) for digital subtraction angiography (DSA) and potential thrombectomy. Potential outcomes on DSA and the functional outcome measure are visualized. Outcomes of interest are indicated with a circled number.
See this image and copyright information in PMC

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