Diaz Maria Lourdes, Carmona Tomás, Requena Manuel, Piñana Carlos, Hernández David, Diana Francesco, De Dios Marta, Farrero Jordi, Ribo Marc, Fredes Araya Arturo, Gramegna Laura Ludovica, Purroy Francisco, Fernandez Leandro, Villalba Jordi, Quintana Manuel, Tomasello Alejandro
Vascular interventional radiology unit, Arnau de Vilanova Hospital, Lleida, Spain.
Neurosurgey unit, Hospital San Pablo, Coquimbo, Chile.
Clin Neuroradiol. 2025 Mar;35(1):35-41. doi: 10.1007/s00062-024-01440-0. Epub 2024 Aug 23.
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.
目的:机械取栓术(MT)通常由经验丰富的神经介入放射科医生进行。然而,后勤和地理限制常常阻碍快速MT的实施。本研究报告了首次使用TEGUS远程指导来支持非综合性卒中中心的普通介入放射科医生(IR)进行MT的临床经验,并与现场指导的结果进行比较。 方法:西班牙的阿诺·德·维拉诺瓦医院过去常将需要MT的卒中患者转运至160公里外的综合性卒中中心。为克服新冠疫情期间的出行限制,安装了Tegus远程指导系统。在进行远程指导之前,普通介入放射科医生在初级卒中中心接受了为期六个月的神经介入培训。从2021年4月至2023年5月,普通IR在现场指导监督或远程指导支持下进行MT。我们旨在比较根据指导方式接受MT的患者的临床结局。 结果:在研究期间,共进行了49例MT:其中15例采用Tegus远程指导,34例采用现场指导。除美国国立卫生研究院卒中量表(NIHSS)评分外,两组的基线特征相似(Tegus组为9[四分位间距6 - 20],现场指导组为18[四分位间距12 - 22],p = 0.034)。门到再灌注时间无显著差异(82±28.2分钟 vs 84±26.4分钟,p = 0.895)。根据卒中严重程度进行调整后,最终的改良脑梗死溶栓分级(mTICI)分布和90天改良Rankin量表(mRS)评分具有可比性。两组均未报告有症状性颅内出血。 结论:本研究表明了在远程医院MT急诊病例中使用Tegus远程远程指导的可行性。它可以改善MT经验有限的介入放射科医生的学习曲线,并降低与MT相关的地域不平等。
Ann Neurol. 2018-9-23