Flying Intervention Team vs Patient Interhospital Transfer in Acute Ischemic Stroke

In a nonrandomized controlled intervention study published in JAMA, researchers in Germany asked if deployment of a flying intervention team, consisting of a neurointerventional radiologist and an angiography assistant, was associated with a shorter time to endovascular thrombectomy for patients in rural or intermediate population areas in Southeast Bavaria, since timely treatment with mechanical thrombectomy can be difficult for patients to access if they live far from hospitals staffed for endovascular services.

Adults with acute ischemic stroke due to large vessel occlusion presented to one of 13 participating primary stroke centers in the Telemedic Stroke Network in Southeast Bavaria equipped with an angio suite but lacking onsite neurointerventional expertise. Patients were allocated by week of presentation to either conventional interhospital transfer to a comprehensive stroke center for treatment, or on-site treatment by the flying intervention team.

In the conventional treatment group, assessed patients requiring endovascular thrombectomy were transferred to one of 5 comprehensive stroke centers for treatment, 3 located in lower density population areas and 2 in the Munich metro area.

In contrast, for the flying intervention team group, once patients were determined to require endovascular thrombectomy, a flying intervention team was alerted and deployed via helicopter from one of the 2 comprehensive stroke centers located in Munich. Concurrent with team deployment, patients were prepped for treatment on-site in the primary stroke center's angio suite by a local surgical team.

Both groups received acute stroke treatment at admitting primary stroke centers until decision to pursue endovascular thrombectomy was determined and followed the same standard operating procedures. The primary endpoint of the trial was how quickly thrombectomy was performed after the decision to pursue thrombectomy was reached.