Abstract DP011: Safety and efficacy of remote mentoring in mechanical thrombectomy through live-streaming telestroke system -sustainable local stroke system

Introduction: Acute ischemic stroke requires immediate access to the facility to perform mechanical thrombectomy (MT), however, not all area can afford it 24/7/365. In the field of stroke care, the application of information technologies to enhance healthcare is determined as telestroke , which is expected to improve stroke care globally. Although remote assessment of images and decision-making regarding t-PA eligibility have been reported, feasibility of remote assistance during MT is unclear. We herein report on the safety and efficacy of MT supervised through telestroke system. Methods: Remote surgical guidance was primarily provided for mechanical thrombectomy at a regional hub hospital. Between December 2020 and March 2025, neurosurgeons who had not well experienced MT received supervision of board-certified neuroendovascular surgeons in MT for patients of acute ischemic stroke using Join LiveView(Allm Inc.) live-streaming service. Mentors utilized smartphones or tablets and guided the procedures from outside the operating room. Clinical and procedural outcomes were compared with those of conventional on-site MT performed during the same period. Results: 127 patients were treated under remote supervision and 209 patients underwent conventional thrombectomy. The mean number of passes was 1.7 in both groups. Median puncture-to-recanalization time was 58 minutes in the remote group versus 49 minutes in the conventional group. Rates of successful reperfusion (TICI ≥2b) were 91% and 92%, respectively. Good functional outcome (mRS 0–2 at follow-up) was achieved in 46% of both groups. Mortality was 17% in the remote group and 13% in the conventional group. Rates of symptomatic/asymptomatic SAH were 0%/5% versus 6%/9%, without statistic significance. Conclusions: MT is required to be performed as emergent intervention, including during nights and weekends in any regions. In settings where the availability of specialists is limited, remote surgical support via telestroke system represents a feasible, safe, and effective strategy to ensure the sufficient MT.