Abstract TP146: Remote Teleproctoring Enabling Vascular Interventionists In Primary Stroke Centres To Perform Mechanical Thrombectomy With Comparable Results To Comprehensive Stroke Centres

Abstract

Background: Increasing efficacy of endovascular thrombectomy for ischemic stroke entails a rising demand for intervention outside Comprehensive Stroke Centers (CSC), in regions where time to treatment and transfer delays result in worse outcomes. We explore the use of a remote teleproctoring system to support vascular interventionists in a remote Local Stroke Center (LSC) to safely perform mechanical thrombectomy (MT) in patients with acute ischemic stroke. Methods: Since November 2020, a Tegus Medical Teleproctoring System was installed in a LSC (Arnau de Vilanova Hospital, Lleida) where the potential MT population could be 80-100 procedures/year, however only half that figure is currently being treated, with most patients transferred to the CSC (Vall d’Hebron Hospital, Barcelona) 160 kms away. Since the implementation of this technology, thrombectomy procedures have been performed by vascular interventionists with moderate neurovascular experience at the LSC, remotely assisted by expert neurointerventionists from the CSC. We retrospectively analyzed the safety and effectiveness of MT with the aid of this proctoring System, comparing with procedures performed in the CSC. Results: Ten MT were performed in the LSC, comprising 50% of the acute stroke cases taken to the angiosuite in one year. The thrombectomy technique was combined distal aspiration with stent-retriever in all cases. Seven thrombectomies resulted successful after the first pass (70%), achieving complete/near complete recanalization (TICI 2c/3) in 80% of the cases. Comparing with CSC, median puncture to recanalization time was 31 (26-62) vs 42 (27-67) and the rate of final succesful reperfusion (90% in LSC vs 86.5% in CSC) was similar. No technical or procedural complications were reported. At 90 days, 40% of the patients had a mRS 0-2. A survey exploring the personal experience showed that communication was considered optimal and confidence in decision making was considered high at both ends of the system. Conclusion: Tegus system seems a valuable tool to support vascular interventionists facing a rise in thrombectomy demands in distant LSCs maintaining enough safety, effectiveness and confidence during the procedures. These data should be challenged by prospective studies.