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Basilar artery occlusion: drip-and-ship versus direct-to-center for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria (NEVAS)

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Abstract

Background

Recent clinical trials revealed a substantial clinical benefit for mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO). While urban areas are sufficiently covered with comprehensive stroke centers and MT expertise, rural areas lack such resources. Structured telemedical stroke networks offer rural hospitals instant consultation by stroke experts, enabling swift administration of intravenous thrombolysis (IVT) on-site and transportation for MT. For BAO patients, data on performance and clinical outcomes in telemedical stroke networks are lacking.

Methods

We retrospectively analyzed data from patients with acute BAO eligible for MT: those treated directly in our comprehensive stroke center (direct-to-center/DC) and those treated in rural hospitals that were telemedically consulted by the Neurovascular Network of Southwest Bavaria (NEVAS) and transferred to our center for MT (drip-and-ship, DS). Key time intervals, stroke management performance and functional outcome after 90 days were compared.

Results

Baseline characteristics, including premorbid status and stroke severity, were comparable. Time from symptom onset to IVT was identical in both groups (118 min). There was a delay of 180 min until recanalization in DS patients, mainly due to patient transport for MT. Procedural treatment time intervals, success of recanalization and complications were comparable. Clinical outcome at 3 months follow-up of DS patients was not inferior to DC patients.

Conclusion

We show for the first time that patients with BAO in rural areas benefit from a structured telemedicine network such as NEVAS, regarding both on-site processing and drip-and-ship for MT. Clinical outcomes are comparable among DS and DC patients.

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Data availability

The data that support the findings of this study are available upon reasonable request and in compliance with the local and international ethical guidelines.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurology, LMU University Hospital, LMU, Marchioninistr. 15, 81377, Munich, Germany

    Ilias Masouris, J. Wischmann, R. Schniepp, L. Kellert & F. Schöberl

  2. Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Guenzburg, Günzburg, Germany

    R. Müller & G. F. Hamann

  3. Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany

    L. Fuhry

  4. Institute of Neuroradiology, LMU University Hospital, LMU, Munich, Germany

    C. Trumm & T. Liebig

Authors
  1. Ilias Masouris
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  2. J. Wischmann
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  3. R. Schniepp
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  4. R. Müller
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  5. L. Fuhry
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  6. G. F. Hamann
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  7. C. Trumm
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  8. T. Liebig
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  9. L. Kellert
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  10. F. Schöberl
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Contributions

IM, RS and JW performed the data analysis. IM, LK and FS designed the study. IM wrote the first draft of the paper. RM, AH, LF, CT, TL, LK and FS supervised the study and co-wrote the manuscript. All authors discussed the results, reviewed and commented the manuscript.

Corresponding author

Correspondence to Ilias Masouris.

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Conflicts of interest

The Author(s) declare(s) that there is no conflict of interest.

Ethical approval

All data were collected according to the Declaration of Helsinki. The study was centrally approved by the Ethics Committee of the LMU Munich (protocol: 689-15), as the leading ethics committee.

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Masouris, I., Wischmann, J., Schniepp, R. et al. Basilar artery occlusion: drip-and-ship versus direct-to-center for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria (NEVAS). J Neurol 271, 1885–1892 (2024). https://doi.org/10.1007/s00415-023-12126-x

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  • DOI: https://doi.org/10.1007/s00415-023-12126-x

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