Characteristics of endovascular treatment for Hyperacute In-Flight Stroke

초록

Background and aims: Annually over 2 billion passengers fly on commercial airlines and in-flight medical emergency is different, compared to on-ground emergency. Previous reports estimated in-flight stroke up to 2 percent of total in-flight emergency. However, description of in-flight stroke case series has been limited until now. Here we report the clinical characteristics of mechanical thrombectomy of in-flight stroke cases experienced in our hospital. Methods: Among patients registered in the prospective Inha stroke and transient ischemic attack (TIA) registry from January 2001 to October 2019, we performed retrospective review of medical records and captured ischemic stroke which occurred during flight. Routine stroke work up including brain MRI/A and etiologic investigation was performed. Results: A total of 27 in-flight stroke cases were enrolled(Age. 60 ± 13.7 years; 16 men). The main etiology was large artery atherosclerosis(67%) and cardioembolism(22%). The time duration between stroke onset to ER arrival was 4.5± 5.3 hours. All of nine patients with unclear onset were associated with the poorer outcome, defined as mRS 4 or higher. Three persons(11%) received the intravenous thrombolysis and eight patients(30%) underwent the mechanical thrombectomy. Seven patients had successful recanalization. However, three of them became dependent and hemorrhagic conversion occurred in two patients. Conclusions: Main etiology of ischemic in-flight stroke was a large artery atherosclerosis and cardioembolism. Unclear stroke onset during flight and delayed transportation to ER might be the barrier for early revascularization. Proper management of early stroke detection and faster transportation would be necessary for these patients.