Helistroke: neurointerventionalist helicopter transport for interventional stroke treatment: proof of concept and rationale

Hui, Ferdinand; Mekabaty, Amgad El; Schultz, Jacky; Hong, Kelvin; Horton, Karen; Urrutia, Victor C.; Naqvi, Imama; Brast, Shawn; Lynch, John K.; Nadareishvili, Zurab

doi:10.1136/neurintsurg-2017-013050

Cited by 20 publications

(16 citation statements)

References 26 publications

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“… 31 Although it is unclear whether these mortality differences are related to the procedure or perioperative care, some have argued for transportation of the neurointerventionalist to the patient, rather than the other way around. Hui et al 32 reported a single case of LVO stroke where the neurointerventionalist was flown to a nonendovascular Primary Stroke Center and carried out MT there. Patient outcome and disposition were not reported, but the case does provide proof of concept and may justify further investigation.…”

Section: Discussionmentioning

confidence: 99%

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)

2017

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Section: Discussionmentioning

confidence: 99%

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)

2017

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“…23 Transport of mobile neurointerventional teams to sites that have on-site angiographic suites for EVT delivery is another creative solution to the traditional spokeand-hub model. 24,25 Direct transport of patients suspected to have LVO by emergency medical service (EMS) to EVT providing centers can be advantageous compared to taking patients to the closest hospital but would need careful consideration of a number of factors to create an optimized bypass algorithm for a given stroke system. [26][27][28][29][30][31][32] Development of prehospital screening tools with high accuracy for field diagnosis of LVO would facilitate efficient triaging.…”

Section: Discussionmentioning

confidence: 99%

Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States

et al. 2019

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BACKGROUND: The use of endovascular therapy (EVT) in acute ischemic stroke patients with large vessel occlusion (LVO) has rapidly increased in the US following pivotal trials demonstrating its benefit. Information about the contribution of interhospital transfer in improving access to EVT will help organize regional systems of stroke care. METHODS: We analyzed trends of transfer-in EVT from a cohort of 1,863,693 ischemic stroke patients admitted to 2,143 Get With The Guidelines-Stroke participating hospitals between January 2012 and December 2017. We further examined the association between arrival mode and in-hospital outcomes using multivariable logistic regression models. RESULTS: Of the 37,260 patients who received EVT at 639 hospitals during the study period, 42.9% (15,975) arrived to the EVT providing hospital after interhospital transfer. Transfer-in EVT cases increased from 256 in Q1 2012 to 1,422 in Q4 2017, with sharply accelerated increases following Q4 2014 (p<0.001 for change in linear trend). Transfer-in patients were younger, more likely to be of white race, arrive during off-hours and treated at comprehensive stroke centers. Transfer-in patients had significantly longer last known well to EVT initiation time (median 289 min vs 213 min, absolute standardized difference 67.33) but were more likely to have door to EVT initiation time of ≤ 90 minutes (65.6% vs 23.6%, absolute standardized difference 93.18). Inhospital outcomes were worse for transfer-in EVT patients in unadjusted and in risk-adjusted

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“…Other time sensitive procedures such as organ harvest have transported physicians to the patient site to improve time to procedure. Applying this same principle to interventional stroke management, lead to important time delay reductions in a proof of concept study (33).…”

Section: Triage Of Stroke Patients In the Pre-hospital Settingmentioning

confidence: 99%

Pre-hospital Assessment of Large Vessel Occlusion Strokes: Implications for Modeling and Planning Stroke Systems of Care

et al. 2019

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The social and financial burden of stroke is remarkable. Stroke is a leading cause of death and long-term disability worldwide. For several years, intravenous recombinant tissue plasminogen activator (IV rt-PA) remained as the only proven therapy for acute ischemic stroke. However, its benefit is hampered by a narrow therapeutic window and limited efficacy for large vessel occlusion (LVO) strokes. Recent trials of endovascular therapy (EVT) for LVO strokes have demonstrated improved patient outcomes when compared to treatment with medical treatment alone (with or without IV rt-PA). Thus, EVT has become a critical component of stroke care. As in IV rt-PA, time to treatment is a crucial factor with high impact on outcomes. Unlike IV rt-PA, EVT is only available at a limited number of centers. Considering the time sensitive benefit of reperfusion therapies of acute ischemic stroke, costs and logistics associated, it is recommended that regional systems of acute stroke care should be developed. These should include rapid identification of suspected stroke, centers that provide initial emergency care, including administration of IV rt-PA, and centers capable of performing endovascular stroke treatment with comprehensive periprocedural care to which rapid transport can be arranged when appropriate. In the pre-hospital setting, the development of scales easier and quicker to perform than the NIHSS yet with a maintained accuracy for detecting LVO strokes is of paramount importance. Several scales have been developed. On the other hand, the decision whether to transport to a primary stroke center (PSC) or to a comprehensive stroke center (CSC) is complex and far beyond the simple diagnosis of a LVO. Ongoing studies will provide important answers to the best transfer strategy for acute stroke patients. At the same time, the development of new technologies to aid in real time the decision-making process will simplify the logistics of regional systems for acute stroke care and, likely improve patients' outcomes through tailored selection of the most appropriate recanalization strategy and destination center.

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Helistroke: neurointerventionalist helicopter transport for interventional stroke treatment: proof of concept and rationale

Abstract: This proof of concept case is presented for logistical, financial and use-case analysis. As it is a first case, times can likely be improved. We assert that this model may be another option in the spoke-and-hub design of stroke systems of care.

Cited by 20 publications

References 26 publications

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)

Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke)

Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States

Pre-hospital Assessment of Large Vessel Occlusion Strokes: Implications for Modeling and Planning Stroke Systems of Care

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