Remote Teleproctoring with the TEGUS System for Mechanical Thrombectomy in a Non-Comprehensive Stroke Center: Initial Preliminary Data On Clinical Experience.

Autor: Diaz ML; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain., Carmona T; Neurosurgey unit, Hospital San Pablo, Coquimbo, Chile.; Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Requena M; Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.; Stroke unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.; Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain., Piñana C; Interventional radiology unit, Hospital clínico Universitario, Valencia, Spain., Hernández D; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain.; Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.; Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain., Diana F; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain.; Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.; Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain., De Dios M; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain.; Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain., Farrero J; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain., Ribo M; Stroke unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain.; Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain., Fredes Araya A; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain., Gramegna LL; Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain., Purroy F; Neurology unit, Arnau de Vilanova Hospital, Lleida, Spain., Fernandez L; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain.; Radiology unit, Arnau de Vilanova Hospital, Lleida, Spain., Villalba J; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain.; Vascular interventional radiology unit, Santa Creu I Sant Pau Hospital, Barcelona, Spain., Quintana M; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain., Tomasello A; Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain. alejandrotomasello@gmail.com.; Interventional Neuroradiology Section, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. alejandrotomasello@gmail.com.; Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. alejandrotomasello@gmail.com.; Departamento de Medicina (A.T.), Universitat Autònoma de Barcelona, Barcelona, Spain. alejandrotomasello@gmail.com.
Jazyk: angličtina
Zdroj: Clinical neuroradiology [Clin Neuroradiol] 2024 Aug 23. Date of Electronic Publication: 2024 Aug 23.
DOI: 10.1007/s00062-024-01440-0
Abstrakt: Purpose: Mechanical thrombectomy (MT) is typically performed by experienced neurointerventional radiologists. However, logistical and geographic limitations often hinder access to rapid MT. This study reports the first clinical experience using TEGUS teleproctoring to support MT conducted by general interventional radiologists (IR) at non-comprehensive stroke centers, compared to on-site proctoring outcomes.
Methods: The Arnau de Vilanova Hospital in Spain used to transfer stroke patients requiring MT to a comprehensive Stroke Center 160 km away. To overcome COVID-19 mobility restrictions, the Tegus Teleproctoring System was installed. Before teleproctoring, the general interventional radiologist underwent six months of neurointerventional training at a primary stroke center. From April 2021 to May 2023, general IR conducted MT either with on-site proctor supervision or teleproctoring support. We aim to compare clinical outcome of patients receiving MT according to proctoring method.
Results: During the study, 49 MTs were performed: 15 with TEGUS teleproctoring and 34 with on-site proctoring. Both groups had similar baseline characteristics, except for NIHSS scores (Tegus 9 [IQR 6-20] vs 18 [IQR 12-22], p = 0.034). No significant differences were found in door-to-revascularization time (82 ± 28.2 vs 84 ± 26.4) min, p = (0.895). The final mTICI distribution and 90-day mRS scores were comparable after adjusting by stroke severity. There were no reports of symptomatic intracranial hemorrhage in either group.
Conclusion: This study shows the feasibility of Tegus remote teleproctoring during emergent cases of MT in a remote hospital. It could improve the learning curve of interventional radiologists with limited experience in MT, and lower the territorial inequity associated to MT.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
Externí odkaz: