Training and Supervision of Thrombectomy by Remote Live Streaming Support (RESS) Randomized Comparison Using Simulated Stroke Interventions
Training and Supervision of Thrombectomy by Remote Live Streaming Support (RESS) Randomized Comparison Using Simulated Stroke Interventions
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DOI：
10.1007/s00062-019-00870-5
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发表时间：
2019-12-20
影响因子：
2.8
通讯作者：
Goebell, Einar
中科院分区：
文献类型：
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作者：
Bechstein, Matthias;Buhk, Jan-Hendrik;Goebell, Einar
目的 在缺乏神经介入专家的地区，中风患者被排除在快速血栓切除术之外。测试了视听在线流媒体系统，允许位于神经血管中心的神经介入专家在无需亲自到场的情况下监督和指导在遥远的医院进行的血栓切除术（远程流媒体支持 [RESS]）。方法 六名不专门从事神经介入治疗的放射科医生在 Mentice 血管内模拟器上总共进行了 36 例血栓切除手术。每位放射科医生在交替的传统本地支持（室内专家 [LOS]）和 RESS（使用先进的直播平台执行）下面临六种不同的血管内模拟场景的挑战。结果 两种支持模式均导致两次尝试（每次四分位距 [IQR] 2.0-2.0），直至成功再通。 LOS（中位24.9分钟，IQR 21.0-31.5分钟）和RESS（23.9分钟，IQR 21.7-28.7分钟，p=0.89）之间从首次导管插入到再通的时间没有统计学上的显着差异。支架回收器覆盖的血栓百分比和回收支架回收器时的平均速度（3.7mm/s，IQR 3.25-5.35mm/s vs. 3.6mm/sec，IQR 2.5-4.7）在两组中相似。透视时间没有差异（19.0 分钟，IQR 16.9-23.5 分钟 vs. 19.9 分钟，IQR 15.9-23.5 分钟），RESS 下使用的造影剂中位数呈增加趋势（62.9ml vs. 43.1ml；p=0.055）。结论 这项研究证实了 RESS 在模拟环境中进行血栓切除术的可行性。这为未来的研究奠定了基础，计划分析 RESS 在现实环境中的有效性，并测试它是否可以改善偏远地区血栓切除术经验有限的介入医生的学习曲线。
Purpose Stroke patients are excluded from expeditious thrombectomy in regions lacking neurointerventional specialists. An audiovisual online streaming system was tested, allowing a neurointerventional specialist located at a neurovascular center to supervise and instruct a thrombectomy performed at a distant hospital without being physically present (remote streaming support [RESS]). Methods In total, 36 thrombectomy procedures were performed on a Mentice endovascular simulator by six radiologists not specialized in neurointerventions. Each radiologist was challenged with six different endovascular simulation scenarios under alternating conventional local support (specialist inside the room [LOS]) and RESS, which was performed using an advanced live streaming platform. Results Both support modes led to a median of 2 attempts (interquartile range [IQR] 2.0-2.0 each) until successful recanalization. There was no statistically significant difference in time from first catheter insertion to recanalization between LOS (median 24.9min, IQR 21.0-31.5min) and RESS (23.9min, IQR 21.7-28.7min, p= 0.89). The percentage of thrombi covered by the stent-retriever and average speed when retrieving the stent-retriever (3.7mm/s, IQR 3.25-5.35mm/s vs. 3.6mm/sec, IQR 2.5-4.7) were similar in both groups. Fluoroscopy time did not differ (19.0min, IQR 16.9-23.5min vs. 19.9min, IQR 15.9-23.5min) with a trend towards increased median amounts of contrast medium used under RESS (62.9ml vs. 43.1ml; p= 0.055). Conclusion This study confirmed the feasibility of RESS for thrombectomy procedures in a simulated environment. This serves as basis for future studies planned to analyze the effectiveness of RESS in a real-world environment and to test if it improves the learning curve of interventionalists with limited thrombectomy experience in remote areas.