BackgroundPrompt endovascular care of patients with ischemic stroke due to large vessel occlusion (LVO) remains a major challenge in rural regions as primary stroke centers (PSC) usually cannot provide neuro-interventional services. Objective The core content of the Flying Intervention Team (FIT) project is to perform thrombectomy on-site at a local PSC after the neuro-interventionalist has been transported via helicopter to the target hospital. An important and so far unanswered question is whether mechanical thrombectomy can be performed as safely and successfully on-site as in a specialized comprehensive stroke center (CSC).MethodsComparison of 100 FIT thrombectomies on site in 14 different PSCs with 128 control thrombectomies at 1 CSC (79 drip-and-ship, 49 mothership) performed by a single interventionalist with respect to technical-procedural success parameters, procedural times, and complications.ResultsThere were no significant differences between the two groups in terms of technical success (95.0% successful interventions in FIT group vs. 94.5% in control group,p= 0.60) and complications (3% major complications in FIT vs. 1.6% in control group,p= 0.47). Regarding time from onset to groin puncture, there was no difference between FIT and the entire control group (182 vs. 183 min,p= 0.28), but a trend in favor of FIT compared with the drip-and-ship control subgroup (182 vs. 210 min,p= 0.096).ConclusionsAirborne neuro-interventional thrombectomy service is a feasible approach for rural regions. If performed by experienced neuro-interventionalists, technical success and complication rates are comparable to treatment in a specialized neuro-interventional department.Supplementary InformationThe online version of this article (10.1007/s00062-022-01220-8) contains supplementary material, which is available to authorized users.