title: Endovascular Treatment of a Severe Stroke Occurring in a Commercial Airplane Over the Sahara.
abstract: BACKGROUND
  The occurrence of an acute stroke syndrome during a long-distance flight demands critical decisions from the crew and attendant physicians. One in particular is whether the flight should be continued or be detoured to a nearby airport.
  
  
  METHODS
  We describe a 42-yr-old woman who suffered from a severe stroke in a commercial airplane over the Sahara. The captain, together with a physician aboard and the next of kin, decided not to detour to north African or south European airports, but to continue flying to Frankfurt, Germany (final destination; remaining flight time 4 h), where an efficient transfer infrastructure and an advanced medical standard were presumed. At the hospital, the patient was successfully treated by means of catheter-based mechanical thrombus extraction. The patient was free of neurological deficits at discharge.
  
  
  CONCLUSIONS
  The geographically unbalanced availability of complex but highly effective therapies such as mechanical recanalization in acute stroke challenges decision making in aviation medicine. In selected cases it might be beneficial to continue flying to cities with advanced medical standards instead of deviating to nearby airports. Foerch C, Mayer CA, Berkefeld J, You S-J. Endovascular treatment of a severe stroke occurring in a commercial airplane over the Sahara. Aerosp Med Hum Perform. 2016; 87(9):825-829.
authors.affiliation: Department of Neurology and the Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Foerch
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Mayer
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Se-Jong
authors.initials: SJ
authors.lastname: You
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D000352:Africa, Northern; D001359:Aviation; D001921:Brain / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D003657:Decision Making; D057510:Endovascular Procedures; D005260:Female; D005858:Germany; D006297:Health Services Accessibility; D006801:Humans; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D017131:Thrombectomy; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed