Remote neuro-endovascular consultation using a secure telemedicine system: A feasibility study

BACKGROUND: Telemedicine has been rapidly implemented under COVID-19 conditions, to assess the ability to use an audio-visual telemedicine system for neuro-endovascular remote consultation. METHODS: The system consists of a live streaming function for angiography and an operating room (OR) camera using a smartphone application (JOIN; Allm Inc, Tokyo, Japan) in conjunction with verbal communication using the Zoom app. The system allows us to display multiple angiographic images in addition to streaming video from the 4K camera recording the operator’s procedure and from the 4K camera showing the OR view on the monitor of any smart device. RESULTS: The operator was able to speak with the senior supervisor through a bone conduction headphone and to talk to assistants or radiology technicians without any hearing difficulties. The remote supervisor was able to check the streaming images, which had almost the same imaging quality as real digital subtraction angiogram (DSA) monitors, and he could advise the handling of devices and preparation through the 4K video camera systems. The DSA image delay was within 2 s. CONCLUSION: A remote consultation system with real-time audio-visual capability may play an important role in acute stroke management and maintain the quality of patient care under COVID-19 conditions.