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  • 1
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    Abstract 95: High Proportion Of Granulocytes Form Intracranial Thrombus Is Associated With Increased Stiffness And Resistance To Endovascular Recanalization
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Hypothesis: We aim to identify a profile of intracranial thrombus resistant to recanalization by standard mechanical thrombectomy (MT) in acute stroke treatment. Methods: First extracted clot of each MT were analyzed by Flow Cytometry obtaining composition of main leukocyte populations: granulocytes, monocytes and lymphocytes. Demographics, reperfusion treatment and grade of recanalization were registered. MT Failure ( MTF) was defined as final Thrombolysis in Cerebral Infarction score IIa or lower and/ or need of permanent intracranial stenting as a rescue therapy after standard MT. In other cohort of cases, unconfined compression tests were performed to explore stiffness of retrieved clots . We looked for correlation between mechanical characterization tests and clot composition. Results: Among 225 patients, there were 13 % of MTF that were significantly associated to atherosclerosis etiology ( 33.3% vs. 15.9% ; p 0.021) , more passes ( 3 vs. 2; p 〈 0.001), higher proportion of clot granulocytes ( 82.46% vs. 68.90% ; p 〈 0.001) and lower proportion of clot monocytes ( 9.18% vs.17.34% ; p 〈 0.001). The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01-1.14) remained as an independent marker of MTF. Among Thirty eight clots tested by unconfined compression median clot stiffness was 30.2 (IQR, 18.9-42.7) kPa. There was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson’s r=0.35, p=0.032). Conclusions: There is a positive correlation between granulocyte proportion and thrombi stiffness that may explain endovascular resistance to recanalization. Influence of granulocytes within thrombus may be a target for future reperfusion treatments.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.95
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    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 2
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    Abstract TMP89: Thrombus Cellular Composition Predicts Unexpected Early Intracranial Reocclusion After Successful Mechanical Thrombectomy
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: Our objective is to identify thrombus composition and related factors associated with unexpected early intracranial reoclussion ( EIR) after successful mechanical thrombectomy ( MT). Methods: Endovascular treatments of patients with acute intracranial or extracranial stenting were excluded. A total of 206 patients with successful reperfusion ( mTICI ≥ 2b) were included . Each intracranial thrombi obtained by MT were analyzed by Flow Cytometry analysis to provide proportion of main leukocyte composition: granulocytes, monocytes and lymphocyte populations. Thrombi analysis, antithrombotic treatment, etiology , reperfusion treatment features, neuroimaging and other baseline variables were analyzed to identify predictors of early reoclussion in the first 48 hours after thrombectomy . Results: EIT were observed in 5.8 %( 12/206) of successfully reperfused strokes. Patients with EIR were younger [ 67 years ( 47-80) vs. 76 years ( 66-84) ; p = 0.046] with lower basal NIHSS [ 17 ( 10-21) vs. 18 ( 11-21) ; p = 0.022] . Thrombi from patients with EIR had higher proportion of lymphocytes B [1.41 % ( 0.48-2.42) vs. 0.44 %(0.16-1.19) ;p = 0.018] in comparison to cases without reoclussion. Basilar artery occlusion ( BAO) [ 2 (15.4%) vs. 8 (4,3%) ; p 0.081 ] and active smoking [ 4( 30.8%) vs. 24 (12.4%) p =0.062] presented a positive trend with EIR cases . In the logistic regression analysis adjusted by age, previous use of intravenous fibrinolysis, number of endovascular passes , proportion of Lymphocytes B, BAO and active smoking , the independent predictor of early reoclussion was the proportion of Lymphocyte B in intracranial thrombus ( aOR 1.363 , 95% CI 1.060- 1.753). Conclusions: Rich B-Lymphocyte- Thrombus predicts unexpected early intracranial reoclusion after successful mechanical thrombectomy
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.TMP89
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
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  • 3
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    Multiparametric Neuroimaging and Its Association with Non-Contrast Computed Tomography in Late-Window Large Vessel Occlusion Acute Stroke
    S. Karger AG ; 2023
    In:  Cerebrovascular Diseases Vol. 52, No. 3 ( 2023), p. 344-352
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 52, No. 3 ( 2023), p. 344-352
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 and 24 h is established as a standard of care among patients selected by multiparametric neuroimaging. We aimed to explore neuroimaging parameters in late-window large vessel occlusion (LVO) patients and its association with non-contrast computed tomography (NCCT) findings. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We included consecutive AIS patients within 6–24 h from the symptoms onset with LVO. We described multiparametric imaging findings, the rate of patients who fulfilled imaging perfusion criteria according to the DAWN and DEFUSE-3 trials that define the computed tomography perfusion mismatch (CTP-MM) group and its association with NCCT focused on Alberta Stroke Program Early CT Score (ASPECTS). We also analyzed the association between neuroimaging parameters and the clinical outcome determined by the 90-day modified Rankin scale (mRS). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 We included 206 patients, of them, 176 (85.4%) presented CTP-MM and 184 (89.3%) presented an ASPECTS ≥6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥6, compared with 40.9% in those with low ASPECTS. ASPECTS was moderately correlated with ischemic core determined by cerebral blood flow & #x3c;30% volume (rS = −0.557, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR: 3.38; 95% CI: 1.01–11.29; 〈 i 〉 p 〈 /i 〉 = 0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR: 1.39; 95% CI: 0.58–3.34; 〈 i 〉 p 〈 /i 〉 = 0.459). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 A great majority of patients who presented a LVO in the late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥6). Our data suggest that NCCT with CT angiography could be a reasonable approach for AIS treatment selection also in the late window.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000526477
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2023
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  • 4
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    Intracranial Artery Calcifications Profile as a Predictor of Recanalization Failure in Endovascular Stroke Treatment
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. 2 ( 2023-02), p. 430-438
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. 2 ( 2023-02), p. 430-438
    Abstract: Acute ischemic stroke with large or medium-vessel occlusion associated with intracranial artery calcification (IAC) is an infrequent phenomenon presumably associated with intracranial atherosclerotic disease. We aimed to characterize IAC and its impact on endovascular treatment outcomes. Methods: We performed a retrospective cross-sectional study of consecutive patients with stroke treated with thrombectomy from January 2020 to July 2021 in our institution. We described IAC findings (length, density, and location pattern) on baseline noncontrast computed tomography. Patients were divided into 3 groups: IAC related to the occlusion location (symptomatic-IAC group), unrelated to the occlusion (asymptomatic-IAC group), and absence of any IAC (non-IAC group). We analyzed the association between the IAC profile and outcomes using logistic regression models. Intracranial angioplasty and stenting were considered rescue treatments. Results: Of the 393 patients included, 26 (6.6%) patients presented a symptomatic-IAC, 77 (19.6%) patients an asymptomatic-IAC, and in 290 (73.8%) patients no IAC was observed. The rate of failed recanalization (expanded Thrombolysis in Cerebral Infarction 0-2a) before rescue treatment was higher in symptomatic-IAC (65.4%) than in asymptomatic-IAC (15.6%; P 〈 0.001) or non-IAC (13.4%; P 〈 0.001). Rescue procedures were more frequently performed in symptomatic-IAC (26.9%) than in asymptomatic-IAC (1.3%; P 〈 0.001) and non-IAC (4.1%; P 〈 0.001). After adjusting for identifiable clinical and radiological confounders, symptomatic-IAC emerged as an independent predictor of failed recanalization (odds ratio, 11.89 [95% CI, 3.94–35.91]; P 〈 0.001), adoption of rescue procedures (odds ratio, 12.38 [95% CI, 2.22–69.09]; P =0.004), and poor functional outcome (90-day modified Rankin Scale score ≥3; odds ratio, 3.51 [95% CI, 1.02–12.00]; P =0.046). Conclusions: The presence of IAC related to the occlusion location is associated with worse angiographic and functional outcomes. Therefore, identification of symptomatic-IAC on baseline imaging may guide optimal endovascular treatment strategy, predicting the need for intracranial stenting and angioplasty.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.122.041257
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
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  • 5
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    Abstract WMP63: Artificial Intelligence Assessment Of Non-contrast Ct Increases Intracranial Occlusion Detection As Compared With Ct-angiograhy Readings
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Artificial Intelligence (AI) can assist in vessel occlusion (VO) identification in acute stroke patients. We aim to investigate the impact of using an AI-based software for automated VO detection on non-contrast CT (AI-VO) as compared to CT-Aangiograpphy (CTA). Methods: From April to October 2020 all patients admitted with a suspected acute ischemic stroke underwent urgent non-contrast CT / CTA / CTP and were treated accordingly. Hypoperfusion areas defined as Tmax 〉 6s on CTP (RAPID software), congruent with the clinical symptoms and a vascular territory, were considered VO (CTP-VO: ground truth). In addition, two experienced neuroradiologists blinded to CTP but not to clinical symptoms retrospectively evaluated CT and CTA to identify intracranial VO (CTA-VO). AI-VO was automatically determined by an AI-based software (Methinks). Results: Of the 338 patients included, 157 (46.5%) showed a CTP-VO (median Tmax 〉 6s: 73[29-127]ml). Overall sensitivity to detect CTP-VO was 50.3% for CTA-VO and 66.9% for AI-VO; specificity was 97.8% for CTA-VO and 86.2% for AI-VO. EVT was performed in 103 patients (EVT-VO: 65.6% of CTP-VO; Tmax 〉 6s: 102[63-160]ml); sensitivity to detect EVT-VO was 69% for CTA-VO and 79.6% for AI-VO; specificity was 95.3% for CTA-VO and 79.6% for AI-VO. The probability to detect a CTP-VO was higher with AI than with CTA for distal occlusions (figure). Accordingly, AI-VO sensitivity was higher than CTA-VO for angiographically confirmed M2/M3-MCA occlusions (80.7% vs 34.6%; p=0.002) but not for M1-MCA/ICA occlusions (82.1% Vs 88.1%;p=0.467). Conclusion: AI-assisted vessel occlusion identification on non-contrast CT may be a useful tool in acute stroke evaluation, especially for distal VO identification, potentially increasing endovascular treatment in these cases.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.WMP63
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 6
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    Abstract WP115: Patient Reported Outcomes to Improve the Accuracy of Disability Evaluation After Endovascular Treatment-Successful Recanalization
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Background: Complete recanalization is a well-known predictor of functional outcome among patients who undergo MT. However, trying to improve recanalization from successful (eTICI ≥ 2b) to complete (eTICI2c-3) with more passes is under debate. PROMS allow an accurate assessment of patients status in different domains after AIS. Hypothesis: In AIS patients undergoing MT, PROMS may allow a more precise characterization of the long-term outcome than the usual mRS according to different degrees of recanalization. Methods: Patients with anterior circulation AIS, treated with MT who achieved a successful recanalization (eTICI ≥ 2b) were included. Patients were classified in two groups according to the degree of recanalization: eTICI 2b (successful) vs eTICI 2c-3 (complete). The collected study variables were baseline, procedural characteristics, and 90 days outcome measures including: assessment of disability by a certified clinician blinded to recanalization status (mRS) and PROMS (PROMIS 10- Physical and Mental, HAD depression and Anxiety, visual EQ-5D scale) Results: From Jan 2020 to Dec 2022, 96 patients with PROMS collection at 90 days were identified: 21 had a final eTICI 2b and 75 a final eTICI2c-3. No differences in terms of age, sex and other baseline and procedural characteristic were observed between groups. Median 90-days mRS was similar in both groups (2 [IQR 1-3]; p= 0.517). At 90 days patients achieving TICI 2c-3 had significantly lower HAD depression score: 7 [3-10] vs 10 [7-15] (p=0.02). All other median PROMS values were numerically favourable for patients who achieved TICI 2c-3: visual EQ-5D scale: 64 [10-80] vs 50 [42-65] (p= 0.1), PROMIS 10-Physical and Mental (eTICI 2b: 12 [10-14] and 12 [9-15] versus eTICI 2c-3: 9[7-12] and 9 [7-12]; p=0.8 and p=0.6 respectively), except for HAD-anxiety score (eTICI 2b: 6 [3-9] versus eTICI 2c-3: 7 [4-9]), p=0.520). More than 250 patients will complete the 90 days follow-up in the next 6 months, analyses will be updated for presentation at the conference Conclusion: The differences observed between patients achieving successful versus complete recanalization indicate that PROMs may be more adequate tool than the usual mRS for a fine-tune characterization of long-term outcome in different quality of life domains
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.WP115
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
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  • 7
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    Granulocytes-Rich Thrombi in Cerebral Large Vessel Occlusion Are Associated with Increased Stiffness and Poorer Revascularization Outcomes
    Springer Science and Business Media LLC ; 2023
    In:  Neurotherapeutics Vol. 20, No. 4 ( 2023-07), p. 1167-1176
    Details
    In: Neurotherapeutics, Springer Science and Business Media LLC, Vol. 20, No. 4 ( 2023-07), p. 1167-1176
    Abstract: We aim to identify a profile of intracranial thrombus resistant to recanalization by mechanical thrombectomy (MT) in acute stroke treatment. The first extracted clot of each MT was analyzed by flow cytometry obtaining the composition of the main leukocyte populations: granulocytes, monocytes, and lymphocytes. Demographics, reperfusion treatment, and grade of recanalization were registered. MT failure (MTF) was defined as final thrombolysis in cerebral infarction score IIa or lower and/or need of permanent intracranial stenting as a rescue therapy. To explore the relationship between stiffness of intracranial clots and cellular composition, unconfined compression tests were performed in other cohorts of cases. Thrombi obtained in 225 patients were analyzed. MTF were observed in 30 cases (13%). MTF was associated with atherosclerosis etiology (33.3% vs. 15.9%; p  = 0.021) and higher number of passes (3 vs. 2; p   〈  0.001). Clot analysis of MTF showed higher percentage of granulocytes [82.46 vs. 68.90% p   〈  0.001] and lower percentage of monocytes [9.18% vs.17.34%, p   〈  0.001] in comparison to successful MT cases. The proportio n of clot granulocytes (aOR 1.07; 95% CI 1.01–1.14) remained an independent marker of MTF. Among thirty-eight clots mechanically tested, there was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson’s r  = 0.35, p  = 0.032), with a median clot stiffness of 30.2 (IQR, 18.9–42.7) kPa. Granulocytes-rich thrombi are harder to capture by mechanical thrombectomy due to increased stiffness, so a proportion of intracranial granulocytes might be useful to guide personalized endovascular procedures in acute stroke treatment.
    Type of Medium: Online Resource
    ISSN: 1933-7213 , 1878-7479
    URL: Article
    DOI: 10.1007/s13311-023-01385-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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  • 8
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    Abstract WMP66: Multiparametric Neuroimaging And Its Association With Non-Contrast Computed Tomography In Late Window Large Vessel Occlusion Acute Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background: Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 to 24 hours is established as a standard of care among patients selected by multiparametric neuroimaging. Therefore, we aimed to explore neuroimaging parameters in late window AIS large vessel occlusion (LVO) patients and the association between findings in non-contrast computed tomography (NCCT) and multiparametric CT. Methods: We included consecutive AIS patients within 6-24 hours from symptoms onset with CTA-LVO. We studied potential associations between computed tomography mismatch defined by DAWN and/or DEFUSE-3 neuroimaging criteria (CTP-MM), infarct volume on CTP, and ASPECTS on NCCT. We also analyzed the association between neuroimaging parameters and outcome determined by 90-day mRS. Results: We included 206 patients, of which 176 (85.4%) presented CTP-MM and 184 (89.3%) presented with an ASPECTS ≥ 6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥ 6, as compared with 40.9% in those with low ASPECTS [Figure 1A] . The ASPECTS correlated with infarct core, determined by Cerebral Blood Flow 〈 30% volume (rP=-0.575, P 〈 0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR 3.38; 95%CI 1.01-11.29; P=0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR 1.39; 95% CI 0.58-3.34; P=0.459) [Figure 1B] . Conclusions: A great majority of patients who presented a LVO in late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥ 6). Our data suggest that NCCT with CT angiography is a reasonable approach for acute ischemic stroke treatment selection also in the late window.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.WMP66
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 9
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    Abstract 81: Radial versus Femoral Access for Mechanical Thrombectomy in Patients With Large Vessel Occlusion: A Randomized Clinical Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: Femoral artery is the most used access for mechanical thrombectomy (MT) in stroke patients with a large vessel occlusion. Routine radial access has been proposed as an alternative following cardiology guidelines although its safety and efficacy remain controversial. Hypothesis: Radial access for MT is non-inferior to femoral access in terms of final recanalization. Methods: The study was an investigator-initiated, single-center, evaluator-blinded randomized clinical trial. Stroke patients undergoing MT, with femoral artery patency and radial artery diameter ≥2.5mm were randomly assigned (1:1) to either radial (60 patients) or femoral access (60 patients). The primary binary outcome was successful recanalization (final eTICI score 2b-3) assigned by blinded evaluators. In the per protocol analysis, patients with allocated access failure were considered non-recanalized. We established a non-inferiority margin of -13.2%, considering an acceptable reduction of 15% in the expected recanalization rates. Results: From September 2021 to July 2023, 120 patients were randomly assigned and 114 (57 radial access, 57 femoral access) with confirmed intracranial occlusion on initial angiogram were included in the primary analysis. In the intention to treat analysis, successful recanalization was achieved in 48/57 (84.2%) patients assigned to femoral access and in 54/57(94.7%) patients assigned to radial (adjusted risk difference 3.36%, 95% CI –6.47% to 13%; p 〈 0.001). The lower limit of one-sided 95% CI was –4.8%, which did not cross our predefined margin of -13.2%. Median time from angiography suite arrival to first pass (femoral: 30 (IQR 25-37) minutes versus radial: 41 (IQR 33-62) minutes, p 〈 0.001) and from suite arrival to recanalization (femoral: 42 (IQR 28-74) versus radial: 59.5 (IQR 44-81) minutes, p 〈 0.050) were longer after radial access. Both groups presented one severe access complication and there was no difference in the rate of allocated access failure: radial 6 (10.5%) radial Vs femoral 5 (8.8%) (p=0.751). Conclusion: Among patients who underwent MT, radial access was non-inferior to femoral access in terms of final recanalization. Procedural delays may favor femoral access as default first approach.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.81
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
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  • 10
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    Remote Training of Neurointerventions by Audiovisual Streaming : Experiences from the European ESMINT-EYMINT E-Fellowship Program
    Springer Science and Business Media LLC ; 2023
    In:  Clinical Neuroradiology Vol. 33, No. 1 ( 2023-03), p. 137-145
    Details
    In: Clinical Neuroradiology, Springer Science and Business Media LLC, Vol. 33, No. 1 ( 2023-03), p. 137-145
    Abstract: Remote access of trainees to training centers via video streaming (tele-observership, e‑fellowship) emerges as an alternative to acquire knowledge in endovascular interventions. Situational awareness is a summary term that is also used in surgical procedures for perceiving and understanding the situation and projecting what will happen next. A high situational awareness would serve as prerequisite for meaningful learning success during tele-observerships. We hypothesized that live perception of the angiographical procedures using streaming technology is feasible and sufficient to gain useful situational awareness of the procedure. Methods During a European tele-observership organized by the European Society of Minimally Invasive Neurological Therapy (ESMINT) and its trainee association (EYMINT), a total of six neurointerventional fellows in five countries observed live cases performed by experienced neurointerventionalists (mentors) in six different high-volume neurovascular centers across Europe equipped with live-streaming technology (Tegus Medical, Hamburg, Germany). Cases were prospectively evaluated during a 12-month period, followed by a final questionnaire after completion of the course. Results A total of 102/161 (63%) cases with a 1:1 allocation of fellow and mentor were evaluated during a 12-month period. Most frequent conditions were ischemic stroke (27.5%), followed by embolization of unruptured aneurysms (25.5%) and arteriovenous malformations (AVMs) (15.7%). A high level of situational awareness was reported by fellows in 75.5% of all cases. After finishing the program, the general improvement of neurointerventional knowledge was evaluated to be extensive (1/6 fellows), substantial (3/6), and moderate (2/6). The specific fields of improvement were procedural knowledge (6/6 fellows), technical knowledge (3/6) and complication management (2/6). Conclusion Online streaming technology facilitates location-independent training of complex neurointerventional procedures through high levels of situational awareness and can therefore supplement live hands-on-training. In addition, it leads to a training effect for fellows with a perceived improvement of their neurointerventional knowledge.
    Type of Medium: Online Resource
    ISSN: 1869-1439 , 1869-1447
    URL: Article
    DOI: 10.1007/s00062-022-01192-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
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