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Legere B, Mohamed A, Elsherif S, Saqqur R, Schoenfeld D, Slebonick AM, McCartin M, Price J, Zachrison KS, Edlow JA, Saqqur M, Shuaib A, Thomas SH. Success With Incrementally Faster Times to Endovascular Therapy (SWIFT-EVT): A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024:107964. [PMID: 39182706 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/18/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND A major systematic review and meta-analysis assessing trial data through 2014 (the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials, HERMES) demonstrated that particularly over the initial six hours of acute ischemic stroke (AIS), rapid performance of endovascular therapy (EVT) markedly improves outcomes. The current analysis, Success with Incrementally Faster Times to EVT (SWIFT-EVT), aimed to provide an updated metric summarizing latest estimates for modified Rankin Scale (mRS) improvements accrued by streamlining time to EVT. METHODS A systematic review and meta-analysis was conducted using electronic databases. Eligible studies reported a time-benefit slope with times from AIS onset (or time last known normal) to EVT commencement; the predictor was onset-to-groin (OTG) time. Primary and secondary outcomes were 90-day functional independence (mRS 0-2) and 90-day excellent function (mRS 0-1), respectively. RESULTS Five studies were included. Results showed increased change of good outcome with each hour of pre-EVT time savings for mRS 0-2 for 0-270' (OR 1.25, 95% CI 1.16-1.35, I2 40%) and 271-360' time frame (1.22, 95% CI 1.12-1.33, I2 58%). For the studies assessing mRS 0-1, estimates were found appropriate for both the 0-270' time frame (OR 1.34, 95% CI 1.19-1.51, I2 27%) and the 271-360' time frame (OR 1.20, 95% CI 1.03-1.38, I2 60%). CONCLUSIONS Each hour saved from AIS onset to EVT start is associated with a 22-25% increased odds of achieving functional independence, a useful metric to inform patient-specific and systems planning decisions.
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Affiliation(s)
- Brittney Legere
- Department of Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada.
| | - Ahmed Mohamed
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada.
| | - Salah Elsherif
- Department of Health Sciences, Queens University, Kingston, Ontario, Canada.
| | - Razan Saqqur
- Department of Health, University of Waterloo, Waterloo, Ontario, Canada.
| | - David Schoenfeld
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA.
| | | | - Michael McCartin
- Section of Emergency Medicine, University of Chicago, Chicago, IL, USA.
| | - James Price
- Department of Emergency Medicine, Cambridge University NHS Trust, Cambridge, UK.
| | - Kori S Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA.
| | - Maher Saqqur
- Department of Neurology, University of Toronto, Mississauga, ON, Canada.
| | - Ashfaq Shuaib
- Department of Neurology, University of Alberta, Edmonton, AB, Canada.
| | - Stephen H Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA; Blizard Institute for Neuroscience, Surgery, & Trauma, Barts & The London School of Medicine, London, UK.
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Röhrs KJ, Audebert H. Pre-Hospital Stroke Care beyond the MSU. Curr Neurol Neurosci Rep 2024; 24:315-322. [PMID: 38907812 PMCID: PMC11258185 DOI: 10.1007/s11910-024-01351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW Mobile stroke units (MSU) have established a new, evidence-based treatment in prehospital stroke care, endorsed by current international guidelines and can facilitate pre-hospital research efforts. In addition, other novel pre-hospital modalities beyond the MSU are emerging. In this review, we will summarize existing evidence and outline future trajectories of prehospital stroke care & research on and off MSUs. RECENT FINDINGS The proof of MSUs' positive effect on patient outcomes is leading to their increased adoption in emergency medical services of many countries. Nevertheless, prehospital stroke care worldwide largely consists of regular ambulances. Advancements in portable technology for detecting neurocardiovascular diseases, telemedicine, AI and large-scale ultra-early biobanking have the potential to transform prehospital stroke care also beyond the MSU concept. The increasing implementation of telemedicine in emergency medical services is demonstrating beneficial effects in the pre-hospital setting. In synergy with telemedicine the exponential growth of AI-technology is already changing and will likely further transform pre-hospital stroke care in the future. Other promising areas include the development and validation of miniaturized portable devices for the pre-hospital detection of acute stroke. MSUs are enabling large-scale screening for ultra-early blood-based biomarkers, facilitating the differentiation between ischemia, hemorrhage, and stroke mimics. The development of suitable point-of-care tests for such biomarkers holds the potential to advance pre-hospital stroke care outside the MSU-concept. A multimodal approach of AI-supported telemedicine, portable devices and blood-based biomarkers appears to be an increasingly realistic scenario for improving prehospital stroke care in regular ambulances in the future.
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Affiliation(s)
- Kian J Röhrs
- Department of Neurology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Heinrich Audebert
- Department of Neurology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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Wolcott ZC, English SW. Artificial intelligence to enhance prehospital stroke diagnosis and triage: a perspective. Front Neurol 2024; 15:1389056. [PMID: 38756217 PMCID: PMC11096539 DOI: 10.3389/fneur.2024.1389056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
As health systems organize to deliver the highest quality stroke care to their patients, there is increasing emphasis being placed on prehospital stroke recognition, accurate diagnosis, and efficient triage to improve outcomes after stroke. Emergency medical services (EMS) personnel currently rely heavily on dispatch accuracy, stroke screening tools, bypass protocols and prehospital notification to care for patients with suspected stroke, but novel tools including mobile stroke units and telemedicine-enabled ambulances are already changing the landscape of prehospital stroke care. Herein, the authors provide our perspective on the current state of prehospital stroke diagnosis and triage including several of these emerging trends. Then, we provide commentary to highlight potential artificial intelligence (AI) applications to improve stroke detection, improve accurate and timely dispatch, enhance EMS training and performance, and develop novel stroke diagnostic tools for prehospital use.
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Paxton JH, Keenan KJ, Wilburn JM, Wise SL, Klausner HA, Ball MT, Dunne RB, Kreitel KD, Morgan LF, Fales WD, Madhok D, Barazangi N, McLean ST, Cross K, Distenfield L, Sykes J, Lovoi P, Johnson B, Smith WS. Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. Acad Emerg Med 2024. [PMID: 38643419 DOI: 10.1111/acem.14919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Large-vessel occlusion (LVO) stroke represents one-third of acute ischemic stroke (AIS) in the United States but causes two-thirds of poststroke dependence and >90% of poststroke mortality. Prehospital LVO stroke detection permits efficient emergency medical systems (EMS) transport to an endovascular thrombectomy (EVT)-capable center. Our primary objective was to determine the feasibility of using a cranial accelerometry (CA) headset device for prehospital LVO stroke detection. Our secondary objective was development of an algorithm capable of distinguishing LVO stroke from other conditions. METHODS We prospectively enrolled consecutive adult patients suspected of acute stroke from 11 study hospitals in four different U.S. geographical regions over a 21-month period. Patients received device placement by prehospital EMS personnel. Headset data were matched with clinical data following informed consent. LVO stroke diagnosis was determined by medical chart review. The device was trained using device data and Los Angeles Motor Scale (LAMS) examination components. A binary threshold was selected for comparison of device performance to LAMS scores. RESULTS A total of 594 subjects were enrolled, including 183 subjects who received the second-generation device. Usable data were captured in 158 patients (86.3%). Study subjects were 53% female and 56% Black/African American, with median age 69 years. Twenty-six (16.4%) patients had LVO and 132 (83.6%) were not LVO (not-LVO AIS, 33; intracerebral hemorrhage, nine; stroke mimics, 90). COVID-19 testing and positivity rates (10.6%) were not different between groups. We found a sensitivity of 38.5% and specificity of 82.7% for LAMS ≥ 4 in detecting LVO stroke versus a sensitivity of 84.6% (p < 0.0015 for superiority) and specificity of 82.6% (p = 0.81 for superiority) for the device algorithm (CA + LAMS). CONCLUSIONS Obtaining adequate recordings with a CA headset is highly feasible in the prehospital environment. Use of the device algorithm incorporating both CA and LAMS data for LVO detection resulted in significantly higher sensitivity without reduced specificity when compared to the use of LAMS alone.
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Affiliation(s)
- James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kevin J Keenan
- Department of Neurology, University of California, Davis, Sacramento, California, USA
| | - John M Wilburn
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Stefanie L Wise
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Howard A Klausner
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Matthew T Ball
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Robert B Dunne
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - K Derek Kreitel
- Department of Radiology, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Larry F Morgan
- Department of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - William D Fales
- Department of Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Debbie Madhok
- Department of Emergency Medicine, University of California, San Francisco, California, USA
| | - Nobl Barazangi
- Department of Neurology, California Pacific Medical Center, San Francisco, California, USA
| | - Steven T McLean
- Department of Emergency Medicine, Ascension St. Mary's Hospital, Saginaw, Michigan, USA
| | - Katherine Cross
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | | | - Paul Lovoi
- MindRhythm, Inc., Cupertino, California, USA
| | | | - Wade S Smith
- Department of Neurology, University of California, Davis, Sacramento, California, USA
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Almubayyidh M, Alghamdi I, Parry-Jones AR, Jenkins D. Prehospital identification of intracerebral haemorrhage: a scoping review of early clinical features and portable devices. BMJ Open 2024; 14:e079316. [PMID: 38643005 PMCID: PMC11033659 DOI: 10.1136/bmjopen-2023-079316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/26/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION Prehospital identification of intracerebral haemorrhage (ICH) in suspected stroke cases may enable the initiation of appropriate treatments and facilitate better-informed transport decisions. This scoping review aims to examine the literature to identify early clinical features and portable devices for the detection of ICH in the prehospital setting. METHODS Three databases were searched via Ovid (MEDLINE, EMBASE and CENTRAL) from inception to August 2022 using prespecified search strategies. One reviewer screened all titles, abstracts and full-text articles for eligibility, while a second reviewer independently screened 20% of the literature during each screening stage. Data extracted were tabulated to summarise the key findings. RESULTS A total of 6803 articles were screened for eligibility, of which 22 studies were included for analysis. Among them, 15 studies reported on early clinical features, while 7 considered portable devices. Associations between age, sex and comorbidities with the presence of ICH varied across studies. However, most studies reported that patients with ICH exhibited more severe neurological deficits (n=6) and higher blood pressure levels (n=11) at onset compared with other stroke and non-stroke diagnoses. Four technologies were identified for ICH detection: microwave imaging technology, volumetric impedance phase shift spectroscopy, transcranial ultrasound and electroencephalography. Microwave and ultrasound imaging techniques showed promise in distinguishing ICH from other diagnoses. CONCLUSION This scoping review has identified potential clinical features for the identification of ICH in suspected stroke patients. However, the considerable heterogeneity among the included studies precludes meta-analysis of available data. Moreover, we have explored portable devices to enhance ICH identification. While these devices have shown promise in detecting ICH, further technological development is required to distinguish between stroke subtypes (ICH vs ischaemic stroke) and non-stroke diagnoses.
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Affiliation(s)
- Mohammed Almubayyidh
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Department of Aviation and Marine, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Alghamdi
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Department of Emergency Medical Services, College of Applied Medical Sciences, Khamis Mushait Campus, King Khalid University, Abha, Saudi Arabia
| | - Adrian Robert Parry-Jones
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - David Jenkins
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester, UK
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Favilla CG, Baird GL, Grama K, Konecky S, Carter S, Smith W, Gitlevich R, Lebron-Cruz A, Yodh AG, McTaggart RA. Portable cerebral blood flow monitor to detect large vessel occlusion in patients with suspected stroke. J Neurointerv Surg 2024:jnis-2024-021536. [PMID: 38514189 DOI: 10.1136/jnis-2024-021536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Early detection of large vessel occlusion (LVO) facilitates triage to an appropriate stroke center to reduce treatment times and improve outcomes. Prehospital stroke scales are not sufficiently sensitive, so we investigated the ability of the portable Openwater optical blood flow monitor to detect LVO. METHODS Patients were prospectively enrolled at two comprehensive stroke centers during stroke alert evaluation within 24 hours of onset with National Institutes of Health Stroke Scale (NIHSS) score ≥2. A 70 s bedside optical blood flow scan generated cerebral blood flow waveforms based on relative changes in speckle contrast. Anterior circulation LVO was determined by CT angiography. A deep learning model trained on all patient data using fivefold cross-validation and learned discriminative representations from the raw speckle contrast waveform data. Receiver operating characteristic (ROC) analysis compared the Openwater diagnostic performance (ie, LVO detection) with prehospital stroke scales. RESULTS Among 135 patients, 52 (39%) had an anterior circulation LVO. The median NIHSS score was 8 (IQR 4-14). The Openwater instrument had 79% sensitivity and 84% specificity for the detection of LVO. The rapid arterial occlusion evaluation (RACE) scale had 60% sensitivity and 81% specificity and the Los Angeles motor scale (LAMS) had 50% sensitivity and 81% specificity. The binary Openwater classification (high-likelihood vs low-likelihood) had an area under the ROC (AUROC) of 0.82 (95% CI 0.75 to 0.88), which outperformed RACE (AUC 0.70; 95% CI 0.62 to 0.78; P=0.04) and LAMS (AUC 0.65; 95% CI 0.57 to 0.73; P=0.002). CONCLUSIONS The Openwater optical blood flow monitor outperformed prehospital stroke scales for the detection of LVO in patients undergoing acute stroke evaluation in the emergency department. These encouraging findings need to be validated in an independent test set and the prehospital environment.
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Affiliation(s)
- Christopher G Favilla
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Grayson L Baird
- Department of Interventional Radiology, Brown University, Providence, Rhode Island, USA
| | | | | | - Sarah Carter
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wendy Smith
- Department of Diagnostic Imaging, Lifespan Health System, Providence, Rhode Island, USA
| | - Rebecca Gitlevich
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexa Lebron-Cruz
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan A McTaggart
- Department of Interventional Radiology, Brown University, Providence, Rhode Island, USA
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Yang S, Baeg E, Kim K, Kim D, Xu D, Ahn JH, Yang S. Neurodiagnostic and neurotherapeutic potential of graphene nanomaterials. Biosens Bioelectron 2024; 247:115906. [PMID: 38101185 DOI: 10.1016/j.bios.2023.115906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/06/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
Graphene has emerged as a highly promising nanomaterial for a variety of advanced technologies, including batteries, energy, electronics, and biotechnologies. Its recent contribution to neurotechnology is particularly noteworthy because its superior conductivity, chemical resilience, biocompatibility, thermal stability, and scalable nature make it well-suited for measuring brain activity and plasticity in health and disease. Graphene-mediated compounds are microfabricated in two central methods: chemical processes with natural graphite and chemical vapor deposition of graphene in a film form. They are widely used as biosensors and bioelectronics for neurodiagnostic and neurotherapeutic purposes in several brain disorders, such as Parkinson's disease, stroke, glioma, epilepsy, tinnitus, and Alzheimer's disease. This review provides an overview of studies that have demonstrated the technical advances of graphene nanomaterials in neuroscientific and clinical applications. We also discuss current limitations and future demands in relation to the clinical application of graphene, highlighting its potential technological and clinical significance for treating brain disorders. Our review underscores the potential of graphene nanomaterials as powerful tools for advancing the understanding of the brain and developing new therapeutic strategies.
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Affiliation(s)
- Sunggu Yang
- Department of Nano-bioengineering, Incheon National University, Incheon, 22012, Republic of Korea; Center for Brain-Machine Interface, Incheon National University, Incheon, 22012, Republic of Korea; gBrain Inc., Incheon, 21984, Republic of Korea.
| | - Eunha Baeg
- Department of Nano-bioengineering, Incheon National University, Incheon, 22012, Republic of Korea
| | - Kyungtae Kim
- Department of Nano-bioengineering, Incheon National University, Incheon, 22012, Republic of Korea
| | - Donggue Kim
- Department of Nano-bioengineering, Incheon National University, Incheon, 22012, Republic of Korea
| | - Duo Xu
- School of Electrical & Electronic Engineering, Yonsei University, Seoul, 03722, Republic of Korea
| | - Jong-Hyun Ahn
- School of Electrical & Electronic Engineering, Yonsei University, Seoul, 03722, Republic of Korea.
| | - Sungchil Yang
- Department of Neuroscience, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon, Hong Kong.
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Ospel JM, Dmytriw AA, Regenhardt RW, Patel AB, Hirsch JA, Kurz M, Goyal M, Ganesh A. Recent developments in pre-hospital and in-hospital triage for endovascular stroke treatment. J Neurointerv Surg 2023; 15:1065-1071. [PMID: 36241225 DOI: 10.1136/jnis-2021-018547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
Abstract
Triage describes the assignment of resources based on where they can be best used, are most needed, or are most likely to achieve success. Triage is of particular importance in time-critical conditions such as acute ischemic stroke. In this setting, one of the goals of triage is to minimize the delay to endovascular thrombectomy (EVT), without delaying intravenous thrombolysis or other time-critical treatments including patients who cannot benefit from EVT. EVT triage is highly context-specific, and depends on availability of financial resources, staff resources, local infrastructure, and geography. Furthermore, the EVT triage landscape is constantly changing, as EVT indications evolve and new neuroimaging methods, EVT technologies, and adjunctive medical treatments are developed and refined. This review provides an overview of recent developments in EVT triage at both the pre-hospital and in-hospital stages. We discuss pre-hospital large vessel occlusion detection tools, transport paradigms, in-hospital workflows, acute stroke neuroimaging protocols, and angiography suite workflows. The most important factor in EVT triage, however, is teamwork. Irrespective of any new technology, EVT triage will only reach optimal performance if all team members, including paramedics, nurses, technologists, emergency physicians, neurologists, radiologists, neurosurgeons, and anesthesiologists, are involved and engaged. Thus, building sustainable relationships through continuous efforts and hands-on training forms an integral part in ensuring rapid and efficient EVT triage.
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Affiliation(s)
- Johanna M Ospel
- Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Neurointerventional Program, Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | | | - Aman B Patel
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Martin Kurz
- Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Mayank Goyal
- Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Aravind Ganesh
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Keenan KJ, Smith WS, Jadhav AP, Haussen DC, Budzik RF, Bonafé A, Bhuva P, Yavagal DR, Ribò M, Cognard C, Hanel RA, Hassan AE, Sila CA, Saver JL, Liebeskind DS, Jovin TG, Nogueira RG. Large vessel occlusion prediction scale thresholds that are sensitive for DAWN Trial patients. Interv Neuroradiol 2023:15910199231203266. [PMID: 37915142 DOI: 10.1177/15910199231203266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Large vessel occlusion (LVO) prediction scales are used to triage prehospital suspected stroke patients with a high probability of LVO stroke to endovascular therapy centers. The sensitivities of these scales in the 6-to-24-h time window are unknown. Higher scale score thresholds are typically less sensitive and more specific. Knowing the highest scale score thresholds that remain sensitive could inform threshold selection for clinical use. Sensitivities may also vary between left and right-sided LVOs. METHODS LVO prediction scale scores were retrospectively calculated using the National Institutes of Health Stroke Scale (NIHSS) scores of patients enrolled in the DAWN Trial. All patients had last known well times between 6 and 24 h, NIHSS scores ≥ 10, intracranial internal carotid artery or proximal middle cerebral artery occlusions, and mismatches between their clinical severities and infarct core volumes. Scale thresholds with sensitivities ≥ 85% were identified, along with scores ≥ 5% more sensitive for left or right-sided LVOs. Specificities could not be calculated because all patients had LVOs. RESULTS A total of 201 out of 206 patients had the required NIHSS subitem scores. CPSS = 3, C-STAT ≥ 2, FAST-ED ≥ 4, G-FAST ≥ 3, RACE ≥ 5, and SAVE ≥ 3 were the highest thresholds that were still 85% sensitive for DAWN Trial LVO stroke patients. RACE ≥ 5 was the only typically used score threshold more sensitive for right-sided LVOs, though similar small differences were seen for other scales at higher thresholds. CONCLUSIONS Our findings likely represent the maximum sensitivities of the LVO prediction scales tested for ideal thrombectomy candidates in the 6-to-24-h time window because NIHSS scores were documented in hospitals during a clinical trial rather than in the prehospital setting. Patients with NIHSS scores < 10 or more distal LVOs would lower sensitivities further. Selecting even higher scale thresholds for LVO triage would lead to many missed LVO strokes.
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Affiliation(s)
- Kevin J Keenan
- Department of Neurology, University of California, Davis, Sacramento, CA, USA
| | - Wade S Smith
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Ashutosh P Jadhav
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Diogo C Haussen
- Department of Neurology and Radiology, Emory University School of Medicine at Grady Memorial Hospital, Atlanta, GA, USA
| | - Ronald F Budzik
- Department of Radiology, OhioHealth/Riverside Methodist Hospital, Columbus, OH, USA
| | - Alain Bonafé
- Department of Neuroradiology, University Hospital of Montpellier, Hop Gui de Chauliac, Montpellier, France
| | - Parita Bhuva
- Texas Stroke Institute at HCA North Texas, Plano, TX, USA
| | - Dileep R Yavagal
- Department of Neurology, University of Miami School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Marc Ribò
- Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Neurology, Vall d'Hebron University Hospital, Stroke Unit, Barcelona, Spain
| | - Christophe Cognard
- Department of Neuroradiology, Hospital Purpan, Toulouse, Midi-Pyrénées, France
| | - Ricardo A Hanel
- Baptist Medical Center Jacksonville/Lyerly Neurosurgery, Jacksonville, FL, USA
| | - Ameer E Hassan
- Department of Neurology, Valley Baptist Medical Center - Harlingen, TX, USA
| | - Cathy A Sila
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey L Saver
- Department of Neurology, University of California, Los Angeles, CA, USA
| | | | - Tudor G Jovin
- Cooper Hospital University Medical Center, Camden, NJ, USA
| | - Raul G Nogueira
- Department of Neurology, UPMC Stroke Institute, University of Pittsburgh, Pittsburgh, PA, USA
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10
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Guo X, Dye J. Modern Prehospital Screening Technology for Emergent Neurovascular Disorders. Adv Biol (Weinh) 2023; 7:e2300174. [PMID: 37357150 DOI: 10.1002/adbi.202300174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/14/2023] [Indexed: 06/27/2023]
Abstract
Stroke is a serious neurological disease and a significant contributor to disability worldwide. Traditional in-hospital imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) remain the standard modalities for diagnosing stroke. The development of prehospital stroke detection devices may facilitate earlier diagnosis, initiation of stroke care, and ultimately better patient outcomes. In this review, the authors summarize the features of eight stroke detection devices using noninvasive brain scanning technology. The review summarizes the features of stroke detection devices including portable CT, MRI, transcranial Doppler ultrasound , microwave tomographic imaging, electroencephalography, near-infrared spectroscopy, volumetric impedance phaseshift spectroscopy, and cranial accelerometry. The technologies utilized, the indications for application, the environments indicated for application, the physical features of the eight stroke detection devices, and current commercial products are discussed. As technology advances, multiple portable stroke detection instruments exhibit the promising potential to expedite the diagnosis of stroke and enhance the time taken for treatment, ultimately aiding in prehospital stroke triage.
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Affiliation(s)
- Xiaofan Guo
- Department of Neurology, Loma Linda University, Loma Linda, CA, 92354, USA
| | - Justin Dye
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, 92354, USA
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11
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Fladt J, Ospel JM, Singh N, Saver JL, Fisher M, Goyal M. Optimizing Patient-Centered Stroke Care and Research in the Prehospital Setting. Stroke 2023; 54:2453-2460. [PMID: 37548010 DOI: 10.1161/strokeaha.123.044169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Over the past decades, continuous technological advances and the availability of novel therapies have enabled treatment of more acute medical conditions than ever before. Many of these treatments, such as intravenous thrombolysis and mechanical thrombectomy for acute ischemic stroke, are highly time sensitive. This has raised interest in shifting advanced acute care from hospitals to the prehospital setting. Key objectives of advanced prehospital stroke care may include (1) early targeted treatments in the prehospital setting, for example, intravenous thrombolysis for acute stroke, and (2) advanced prehospital diagnostics such as prehospital large vessel occlusion and intracranial hemorrhage detection, to help inform patient triage and potentially reduce subsequent workload in emergency departments. Major challenges that may hamper a swift transition to more advanced prehospital care are related to conducting clinical trials in the prehospital setting to provide sufficient evidence for emergency interventions, as well as ambulance design, infrastructure, emergency medical service personnel training and workload, and cost barriers. Utilizing new technologies such as telemedicine, mobile stroke units and portable diagnostic devices, customized software applications, and smart storage space management may help surmount these challenges and establish efficient, targeted care strategies that are achievable in the prehospital setting. In this article, we delineate the paradigm of shifting advanced stroke care to the prehospital setting and outline future directions in providing evidence-based, patient-centered prehospital care. While we use acute stroke as an illustrative example, these principles are not limited to stroke patients and can be applied to prehospital triage for any time-critical disease.
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Affiliation(s)
- Joachim Fladt
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Calgary Stroke Program, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada (J.F., J.M.O., M.G.)
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (J.F.)
| | - Johanna M Ospel
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Calgary Stroke Program, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada (J.F., J.M.O., M.G.)
| | - Nishita Singh
- Department of Neurology, University of Manitoba, Winnipeg, Canada (N.S.)
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.F.)
| | - Mayank Goyal
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Calgary Stroke Program, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Canada (J.F., J.M.O., M.G.)
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12
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Habib P, Dimitrov I, Pinho J, Schürmann K, Bach JP, Wiesmann M, Schulz JB, Reich A, Nikoubashman O. Point-of-Care Ultrasound to Detect Acute Large Vessel Occlusions in Stroke Patients: A Proof-of-Concept Study. Can J Neurol Sci 2023; 50:656-661. [PMID: 35872570 DOI: 10.1017/cjn.2022.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A primary admission of patients with suspected acute ischemic stroke and large vessel occlusion (LVO) to centers capable of providing endovascular stroke therapy (EVT) may induce shorter time to treatment and better functional outcomes. One of the limitations in this strategy is the need for accurately identifying LVO patients in the prehospital setting. We aimed to study the feasibility and diagnostic performance of point-of-care ultrasound (POCUS) for the detection of LVO in patients with acute stroke. METHODS We conducted a proof-of-concept study and selected 15 acute ischemic stroke patients with angiographically confirmed LVO and 15 patients without LVO. Duplex ultrasonography (DUS) of the common carotid arteries was performed, and flow profiles compatible with LVO were scored independently by one experienced and one junior neurologist. RESULTS Among the 15 patients with LVO, 6 patients presented with an occlusion of the carotid-T and 9 patients presented with an M1 occlusion. Interobserver agreement between the junior and the experienced neurologist was excellent (kappa = 0.813, p < 0.001). Flow profiles of the CAA allowed the detection of LVO with a sensitivity of 73%, a positive predictive value of 92 and 100%, and a c-statistics of 0.83 (95%CI = 0.65-0.94) and 0.87 (95%CI = 0.69-0.94) (experienced neurologist and junior neurologist, respectively). In comparison with clinical stroke scales, DUS was associated with better trade-off between sensitivity and specificity. CONCLUSION POCUS in acute stroke setting is feasible, it may serve as a complementary tool for the detection of LVO and is potentially applicable in the prehospital phase.
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Affiliation(s)
- Pardes Habib
- Department of Neurology, University Hospital, RWTH Aachen University, Germany
- JARA-BRAIN Institute of Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Ivaylo Dimitrov
- Department of Neurology, University Hospital, RWTH Aachen University, Germany
| | - João Pinho
- Department of Neurology, University Hospital, RWTH Aachen University, Germany
| | - Kolja Schürmann
- Department of Neurology, University Hospital, RWTH Aachen University, Germany
| | - Jan Philipp Bach
- Department of Neurology, University Hospital, RWTH Aachen University, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Germany
| | - Jörg B Schulz
- Department of Neurology, University Hospital, RWTH Aachen University, Germany
- JARA-BRAIN Institute of Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
| | - Arno Reich
- Department of Neurology, University Hospital, RWTH Aachen University, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Germany
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13
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Agrawal D, Dhillon P, Siow I, Lee KS, Spooner O, Yeo L, Bhogal P. Prehospital technologies for early stroke detection - A review. Interv Neuroradiol 2023:15910199231152372. [PMID: 36654460 DOI: 10.1177/15910199231152372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The rate of neural circuitry loss in a typical large vessel occlusion well emphasizes that 'Time is Brain'. Every untreated minute in a large vessel ischaemic stroke results in loss of 1.9 million neurons and 13.8 billion synapses. As such, it is essential to optimize the flow-limiting steps in delivering the current standard of care. The current diagnostic model involves recognition of symptoms by patients, followed by access to Emergency Medical Services and subsequent physical examination and neuroimaging in the Emergency Department. With more than 50% of stroke patients using Emergency Medical Services as the first point of care contact, it can be deduced that the outcome of the 'stroke chain of survival' can be improved by addressing the bottleneck of prehospital stroke diagnosis. Here we present a review of the existing technologies.
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Affiliation(s)
- Deepsha Agrawal
- Department of Radiology, 6397Oxford University Hospitals NHS Trust, Oxford, UK
| | - Permesh Dhillon
- Department of Interventional Neuroradiology, 105590Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Isabel Siow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Oliver Spooner
- Department of Stroke Medicine, 112001The Royal London Hospital, Barts NHS Trust, London, UK
| | - Leonard Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, 112001The Royal London Hospital, Barts NHS Trust, London, UK
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14
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di Biase L, Bonura A, Caminiti ML, Pecoraro PM, Di Lazzaro V. Neurophysiology tools to lower the stroke onset to treatment time during the golden hour: microwaves, bioelectrical impedance and near infrared spectroscopy. Ann Med 2022; 54:2658-2671. [PMID: 36154386 PMCID: PMC9542520 DOI: 10.1080/07853890.2022.2124448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Reperfusion therapy administration timing in acute ischaemic stroke is the main determinant of patients' mortality and long-term disability. Indeed, the first hour from the stroke onset is defined the "golden hour", in which the treatment has the highest efficacy and lowest side effects. Delayed ambulance transport, inappropriate triage and difficulty in accessing CT scans lead to delayed onset to treatment time (OTT) in clinical practice. To date brain CT scan is needed to rule out intracranial haemorrhage, which is a major contraindication to thrombolytic therapy. The availability, dimension and portability make CT suitable mainly for intrahospital use, determining further delays in the therapies administration. This review aims at evaluating portable neurophysiology technologies developed with the scope of speeding up the diagnostic phase of acute stroke and, therefore, the initiation of intravenous thrombolysis. Medline databases were explored for studies concerning near infrared spectroscopy (NIRS), bioelectrical impedance spectroscopy (BIS) and Microwave imaging (MWI) as methods for stroke diagnosis. A total of 1368 articles were found, and 12 of these fit with our criteria and were included in the review. For each technology, the following parameters were evaluated: diagnostic accuracy, ability to differentiate ischaemic and haemorrhagic stroke, diagnosis time from stroke onset, portability and technology readiness level (TRL). All the described methods seem to be able to identify acute stroke even though the number of studies is very limited. Low cost and portability make them potentially usable during ambulance transport, possibly leading to a reduction of stroke OTT along with the related huge benefits in terms of patients outcome and health care costs. In addition, unlike standard imaging techniques, neurophysiological techniques could allow continuous monitoring of patients for timely intrahospital stroke diagnosis.KEY MESSAGESFirst hour from the stroke onset is defined the "golden hour", in which the treatment has the highest efficacy and lowest side effects.The delay for stroke onset to brain imaging time is one of the major reasons why only a minority of patients with acute ischaemic stroke are eligible to reperfusion therapies.Neurophysiology techniques (NIRS, BIS and MWI) could have a potential high impact in reducing the time to treatment in stroke patients.
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Affiliation(s)
- Lazzaro di Biase
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology and Neurobiology, Università Campus Bio-Medico di Roma, Roma, Italy.,Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.,Brain Innovations Laboratory, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Adriano Bonura
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology and Neurobiology, Università Campus Bio-Medico di Roma, Roma, Italy.,Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Maria Letizia Caminiti
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology and Neurobiology, Università Campus Bio-Medico di Roma, Roma, Italy.,Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Pasquale Maria Pecoraro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology and Neurobiology, Università Campus Bio-Medico di Roma, Roma, Italy.,Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Vincenzo Di Lazzaro
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology and Neurobiology, Università Campus Bio-Medico di Roma, Roma, Italy.,Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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15
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Odland IC, Chennareddy S, Kalagara R, Vasan V, Schuldt BR, Downes M, Ali M, Mokin M, Kellner CP. Prehospital Stroke Detection Devices: A Bibliometric Analysis of Current Trends. World Neurosurg 2022; 167:e1360-e1375. [PMID: 36113713 DOI: 10.1016/j.wneu.2022.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stroke represents the second highest disease burden worldwide. It is well documented that rapid stroke identification and treatment are associated with improved outcomes. In particular, prehospital stroke detection (PSD) devices have emerged as possible tools to facilitate more rapid and accurate stroke triage. Bibliometric analyses offer a powerful tool to characterize the entire field from an interdisciplinary perspective. This bibliometric analysis aims to analyze current themes and identify future trends within the PSD space. METHODS The Web of Science collection database was surveyed for PSD literature. Search terms focused on stroke diagnostic techniques, clinical indicators for ischemia/hemorrhage, and prehospital timing. Subsequently, VOSviewer was used for visual mapping analyses. RESULTS A total of 237 documents were identified between 1995 and 2021 from 1190 different authors. Publication volume has increased greatly in recent years. Publications were spread across 156 journals with the largest journal, Stroke, contributing just 7 studies over 26 years. Keywords analysis showed that stroke, near-infrared spectroscopy, and electroencephalography were the most common keywords. CONCLUSIONS Novel PSD devices are promising tools for the early detection and characterization of stroke. This study identifies recent increased attention to PSD technology, a trend that will likely continue in the coming years. Devices using near-infrared spectroscopy, ultrasonography, microwave, and electroencephalography represent the central areas of future PSD research. The multidisciplinary, and therefore fractured, nature of the PSD space requires those interested in the field to maintain active search habits across multiple journals to remain up to date on PSD innovations.
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Affiliation(s)
- Ian C Odland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA; Mount Sinai BioDesign, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA.
| | - Susmita Chennareddy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
| | - Braxton R Schuldt
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
| | - Margaret Downes
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
| | - Maxim Mokin
- University of South Florida, Department of Neurosurgery, Tampa, Florida, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
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16
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Gravino G. The pioneering past and cutting-edge future of interventional neuroradiology. Interv Neuroradiol 2022:15910199221130234. [PMID: 36214159 DOI: 10.1177/15910199221130234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
This review provides a thorough understanding of the developments in the field of interventional neuroradiology (INR). A concise overview of the pioneering past and current state of this field is presented first, followed by a greater emphasis on its future. Five main aspects predicted to undergo significant developments are identified and discussed. These include changes in 'education and training', 'clinical practice and logistics', 'devices and equipment', 'techniques and procedures', and 'relevant diagnostic imaging'. INR is at the crossroads of neuroradiology, neurosurgery, neurology, and the neurosciences. To progress we must value the uniqueness and vitality of this multidisciplinary aspect. While minimal access techniques offer very good anatomical accessibility to treat multiple pathologies of the central nervous system, it is also important to recognise its limitations. Medical, surgical, and radiosurgery modalities retain an important role in the management of some complex neuropathology. This review is certainly not exhaustive of all ongoing and predicted developments, but it is an important update for INR specialists and other interested professionals.
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Affiliation(s)
- Gilbert Gravino
- 195157Neuroradiology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, L9 7LJ, UK
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17
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Patil S, Rossi R, Jabrah D, Doyle K. Detection, Diagnosis and Treatment of Acute Ischemic Stroke: Current and Future Perspectives. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:748949. [PMID: 35813155 PMCID: PMC9263220 DOI: 10.3389/fmedt.2022.748949] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Stroke is one of the leading causes of disability worldwide. Early diagnosis and treatment of stroke are important for better clinical outcome. Rapid and accurate diagnosis of stroke subtypes is critical. This review discusses the advantages and disadvantages of the current diagnostic and assessment techniques used in clinical practice, particularly for diagnosing acute ischemic stroke. Alternative techniques for rapid detection of stroke utilizing blood based biomarkers and novel portable devices employing imaging methods such as volumetric impedance phase-shift spectroscopy, microwave tomography and Doppler ultrasound are also discussed. Current therapeutic approaches for treating acute ischemic stroke using thrombolytic drugs and endovascular thrombectomy are discussed, with a focus on devices and approaches recently developed to treat large cranial vessel occlusions.
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Affiliation(s)
- Smita Patil
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Rosanna Rossi
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Duaa Jabrah
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Karen Doyle
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
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18
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Chennareddy S, Kalagara R, Smith C, Matsoukas S, Bhimani A, Liang J, Shapiro S, De Leacy R, Mokin M, Fifi JT, Mocco J, Kellner CP. Portable stroke detection devices: a systematic scoping review of prehospital applications. BMC Emerg Med 2022; 22:111. [PMID: 35710360 PMCID: PMC9204948 DOI: 10.1186/s12873-022-00663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The worldwide burden of stroke remains high, with increasing time-to-treatment correlated with worse outcomes. Yet stroke subtype determination, most importantly between stroke/non-stroke and ischemic/hemorrhagic stroke, is not confirmed until hospital CT diagnosis, resulting in suboptimal prehospital triage and delayed treatment. In this study, we survey portable, non-invasive diagnostic technologies that could streamline triage by making this initial determination of stroke type, thereby reducing time-to-treatment. METHODS Following PRISMA guidelines, we performed a scoping review of portable stroke diagnostic devices. The search was executed in PubMed and Scopus, and all studies testing technology for the detection of stroke or intracranial hemorrhage were eligible for inclusion. Extracted data included type of technology, location, feasibility, time to results, and diagnostic accuracy. RESULTS After a screening of 296 studies, 16 papers were selected for inclusion. Studied devices utilized various types of diagnostic technology, including near-infrared spectroscopy (6), ultrasound (4), electroencephalography (4), microwave technology (1), and volumetric impedance spectroscopy (1). Three devices were tested prior to hospital arrival, 6 were tested in the emergency department, and 7 were tested in unspecified hospital settings. Median measurement time was 3 minutes (IQR: 3 minutes to 5.6 minutes). Several technologies showed high diagnostic accuracy in severe stroke and intracranial hematoma detection. CONCLUSION Numerous emerging portable technologies have been reported to detect and stratify stroke to potentially improve prehospital triage. However, the majority of these current technologies are still in development and utilize a variety of accuracy metrics, making inter-technology comparisons difficult. Standardizing evaluation of diagnostic accuracy may be helpful in further optimizing portable stroke detection technology for clinical use.
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Affiliation(s)
- Susmita Chennareddy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA.
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - Colton Smith
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - Abhiraj Bhimani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - John Liang
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - Steven Shapiro
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - Reade De Leacy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building, 8th Floor, New York, NY, 10029, USA
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19
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Jin X, Li P, Michalski D, Li S, Zhang Y, Jolkkonen J, Cui L, Didwischus N, Xuan W, Boltze J. Perioperative stroke: A perspective on challenges and opportunities for experimental treatment and diagnostic strategies. CNS Neurosci Ther 2022; 28:497-509. [PMID: 35224865 PMCID: PMC8928912 DOI: 10.1111/cns.13816] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 02/06/2023] Open
Abstract
Perioperative stroke is an ischemic or hemorrhagic cerebral event during or up to 30 days after surgery. It is a feared condition due to a relatively high incidence, difficulties in timely detection, and unfavorable outcome compared to spontaneously occurring stroke. Recent preclinical data suggest that specific pathophysiological mechanisms such as aggravated neuroinflammation contribute to the detrimental impact of perioperative stroke. Conventional treatment options are limited in the perioperative setting due to difficult diagnosis and medications affecting coagulation in may cases. On the contrary, the chance to anticipate cerebrovascular events at the time of surgery may pave the way for prevention strategies. This review provides an overview on perioperative stroke incidence, related problems, and underlying pathophysiological mechanisms. Based on this analysis, we assess experimental stroke treatments including neuroprotective approaches, cell therapies, and conditioning medicine strategies regarding their potential use in perioperative stroke. Interestingly, the specific aspects of perioperative stroke might enable a more effective application of experimental treatment strategies such as classical neuroprotection whereas others including cell therapies may be of limited use. We also discuss experimental diagnostic options for perioperative stroke augmenting classical clinical and imaging stroke diagnosis. While some experimental stroke treatments may have specific advantages in perioperative stroke, the paucity of established guidelines or multicenter clinical research initiatives currently limits their thorough investigation.
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Affiliation(s)
- Xia Jin
- Department of Anesthesiology, Renji Hospital, School of Medicine Shanghai Jiaotong University, Shanghai, China
| | - Peiying Li
- Department of Anesthesiology, Renji Hospital, School of Medicine Shanghai Jiaotong University, Shanghai, China
| | | | - Shen Li
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yueman Zhang
- Department of Anesthesiology, Renji Hospital, School of Medicine Shanghai Jiaotong University, Shanghai, China
| | - Jukka Jolkkonen
- Department of Neurology and A. I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
| | - Lili Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Nadine Didwischus
- School of Life Sciences, University of Warwick, Coventry, UK.,Department of Radiology, University of Pittsburgh, Pittsburgh, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Wei Xuan
- Department of Anesthesiology, Renji Hospital, School of Medicine Shanghai Jiaotong University, Shanghai, China
| | - Johannes Boltze
- School of Life Sciences, University of Warwick, Coventry, UK
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20
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Patra DP, Demaerschalk BM, Chong BW, Krishna C, Bendok BR. A Renaissance in Modern and Future Endovascular Stroke Care. Neurosurg Clin N Am 2022; 33:169-183. [DOI: 10.1016/j.nec.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Li X, Oziel M, Rubinsky B. Evaluating the therapeutic effect of tumor treating fields (TTFields) by monitoring the impedance across TTFields electrode arrays. PeerJ 2022; 10:e12877. [PMID: 35186474 PMCID: PMC8833244 DOI: 10.7717/peerj.12877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Tumor Treating Fields (TTFields), are a novel, non-invasive tissue ablation technology for treatment of cancer. Tissue ablation is achieved through the continuous delivery of a narrow range of electromagnetic fields across a tumor, for a period of months. TTFields are designed to affect only cells that divide and to interfere with the cell division process. The therapy is monitored with MRI imaging, performed every couple of months. Current technology is unable to assess the treatment effectiveness in real time. METHODS We propose that the effect of the treatment can be assessed, in real time, by continuously measuring the change in electrical impedance across the TTFields delivery electrode arrays. An in vitro anatomic skull experimental study, with brain and tumor mimics phantom tissues was conducted to confirm the potential value of the proposed monitoring system. RESULTS Experiments show that measuring the change in the impedance amplitude between opposite TTFields electrode arrays, at a typical TTFields treatment frequency of (200 kHz), can detect changes in the tumor radius with a sensitivity that increases with the radius of the tumor. The study shows that TTFields electrode arrays can be used to assess the effectiveness of TTFields treatment on changes in the tumor dimensions in real time, throughout the treatement. This monitoring system may become a valuable addition to the TTFields cancer treatment technology. It could provide the means to continuously assess the effectiveness of the treatment, and thereby optimize the design of the treatment protocol.
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Affiliation(s)
- Xing Li
- National University of Defense Technology, Electronic Countermeasure Institute, Hefei, Anhui, China
| | - Moshe Oziel
- Department of Physiology and Pharmacology, Tel Aviv University, Tel Aviv, Israel
| | - Boris Rubinsky
- Department of Mechanical Engineering, Department of Bioenegineering, University of California, Berkeley, CA, USA
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22
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Nicholls JK, Ince J, Minhas JS, Chung EML. Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review. Front Neurol 2022; 12:780324. [PMID: 35095726 PMCID: PMC8796731 DOI: 10.3389/fneur.2021.780324] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Large vessel occlusion (LVO) is the obstruction of large, proximal cerebral arteries and can account for up to 46% of acute ischaemic stroke (AIS) when both the A2 and P2 segments are included (from the anterior and posterior cerebral arteries). It is of paramount importance that LVO is promptly recognised to provide timely and effective acute stroke management. This review aims to scope recent literature to identify new emerging detection techniques for LVO. As a good comparator throughout this review, the commonly used National Institutes of Health Stroke Scale (NIHSS), at a cut-off of ≥11, has been reported to have a sensitivity of 86% and a specificity of 60% for LVO. Methods: Four electronic databases (Medline via OVID, CINAHL, Scopus, and Web of Science), and grey literature using OpenGrey, were systematically searched for published literature investigating developments in detection methods for LVO, reported from 2015 to 2021. The protocol for the search was published with the Open Science Framework (10.17605/OSF.IO/A98KN). Two independent researchers screened the titles, abstracts, and full texts of the articles, assessing their eligibility for inclusion. Results: The search identified 5,082 articles, in which 2,265 articles were screened to assess their eligibility. Sixty-two studies remained following full-text screening. LVO detection techniques were categorised into 5 groups: stroke scales (n = 30), imaging and physiological methods (n = 15), algorithmic and machine learning approaches (n = 9), physical symptoms (n = 5), and biomarkers (n = 3). Conclusions: This scoping review has explored literature on novel and advancements in pre-existing detection methods for LVO. The results of this review highlight LVO detection techniques, such as stroke scales and biomarkers, with good sensitivity and specificity performance, whilst also showing advancements to support existing LVO confirmatory methods, such as neuroimaging.
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Affiliation(s)
- Jennifer K. Nicholls
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Medical Physics, University Hospitals of Leicester, NHS Trust, Leicester, United Kingdom
| | - Jonathan Ince
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jatinder S. Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
| | - Emma M. L. Chung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- Department of Medical Physics, University Hospitals of Leicester, NHS Trust, Leicester, United Kingdom
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, United Kingdom
- School of Life Course Sciences, King's College London, London, United Kingdom
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23
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Ramos A, Guerrero WR, Pérez de la Ossa N. Prehospital Stroke Triage. Neurology 2021; 97:S25-S33. [PMID: 34785601 DOI: 10.1212/wnl.0000000000012792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/07/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE REVIEW This article reviews prehospital organization in the treatment of acute stroke. Rapid access to an endovascular therapy (EVT) capable center and prehospital assessment of large vessel occlusion (LVO) are 2 important challenges in acute stroke therapy. This article emphasizes the use of transfer protocols to assure the prompt access of patients with an LVO to a comprehensive stroke center where EVT can be offered. Available prehospital clinical tools and novel technologies to identify LVO are also discussed. Moreover, different routing paradigms like first attention at a local stroke center ("drip and ship"), direct transfer of the patient to an endovascular center ("mothership"), transfer of the neurointerventional team to a local primary center ("drip and drive"), mobile stroke units, and prehospital management communication tools all aimed to improve connection and coordination between care levels are reviewed. RECENT FINDINGS Local observational data and mathematical models suggest that implementing triage tools and bypass protocols may be an efficient solution. Ongoing randomized clinical trials comparing drip and ship vs mothership will elucidate which is the more effective routing protocol. SUMMARY Prehospital organization is critical in realizing maximum benefit from available therapies in acute stroke. The optimal transfer protocols directed to accelerate EVT are under study, and more accurate prehospital triage tools are needed. To improve care in the prehospital setting, efficient tools based on patient factors, local geography, and hospital capability are needed. These tools would optimally lead to individualized real-time decision-making.
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Affiliation(s)
- Anna Ramos
- From the Stroke Unit, Department of Neuroscience (A.R., N.P.O.), University Hospital Germans Trias I Pujol, Badalona, Spain; and Department of Neurosurgery (W.R.G.), University of South Florida Morsani College of Medicine, Tampa
| | - Waldo R Guerrero
- From the Stroke Unit, Department of Neuroscience (A.R., N.P.O.), University Hospital Germans Trias I Pujol, Badalona, Spain; and Department of Neurosurgery (W.R.G.), University of South Florida Morsani College of Medicine, Tampa
| | - Natalia Pérez de la Ossa
- From the Stroke Unit, Department of Neuroscience (A.R., N.P.O.), University Hospital Germans Trias I Pujol, Badalona, Spain; and Department of Neurosurgery (W.R.G.), University of South Florida Morsani College of Medicine, Tampa.
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24
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Jumaa MA, Salahuddin H, Burgess R. The Future of Endovascular Therapy. Neurology 2021; 97:S185-S193. [PMID: 34785617 DOI: 10.1212/wnl.0000000000012807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE REVIEW This article summarizes a broad range of the most recent advances and future directions in stroke diagnostics, endovascular robotics, and neuromodulation. RECENT FINDINGS In the past 5 years, the field of interventional neurology has seen major technological advances for the diagnosis and treatment of cerebrovascular diseases. Several new technologies became available to aid in complex prehospital stroke triage, stroke diagnosis, and interpretation of radiologic findings. Robotics and neuromodulation promise to expand access to established treatments and broaden neuroendovascular indications. SUMMARY Mobile applications offer a solution to simplify prehospital diagnostic and transfer decisions. Several prehospital devices are also under development to improve the accuracy of detection of large vessel occlusion (LVO). Artificial intelligence is now routinely used in early diagnosis of LVO and for detecting salvageability of the affected brain parenchyma. Technological advances have also paved the way to incorporate endovascular robotics and neuromodulation into practice. This may expand the deliverability of established treatments and facilitate the development of cutting-edge treatments for other complex neurologic diseases.
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Affiliation(s)
- Mouhammad A Jumaa
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH.
| | - Hisham Salahuddin
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH
| | - Richard Burgess
- From the Department of Neurology, ProMedica Neurosciences Institute; and Department of Neurology, University of Toledo College of Medicine, OH
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25
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McDonough R, Ospel J, Goyal M. State of the Art Stroke Imaging: A Current Perspective. Can Assoc Radiol J 2021; 73:371-383. [PMID: 34569306 DOI: 10.1177/08465371211028823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Acute stroke is a widespread, debilitating disease. Fortunately, it also has one of the most effective therapeutic options available in medicine, endovascular treatment. Imaging plays a major role in the diagnosis of stroke and aids in appropriate therapy selection. Given the rapid accumulation of evidence for patient subgroups and concurrent broadening of therapeutic options and indications, it is important to recognize the benefits of certain imaging technologies for specific situations. An effective imaging protocol should: 1) be fast, 2) easily implementable, 3) produce reliable results, 4) have few contraindications, and 5) be safe, all with the goal of providing the patient the best chance of achieving a favorable outcome. In the following, we provide a review of the currently available imaging technologies, their advantages and disadvantages, as well as an overview of the future of stroke imaging. Finally, we offer a perspective.
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Affiliation(s)
- Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Johanna Ospel
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mayank Goyal
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
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26
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Chen J, Li G, Liang H, Zhao S, Sun J, Qin M. An amplitude-based characteristic parameter extraction algorithm for cerebral edema detection based on electromagnetic induction. Biomed Eng Online 2021; 20:74. [PMID: 34344370 PMCID: PMC8335876 DOI: 10.1186/s12938-021-00913-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cerebral edema is a common condition secondary to any type of neurological injury. The early diagnosis and monitoring of cerebral edema is of great importance to improve the prognosis. In this article, a flexible conformal electromagnetic two-coil sensor was employed as the electromagnetic induction sensor, associated with a vector network analyzer (VNA) for signal generation and receiving. Measurement of amplitude data over the frequency range of 1–100 MHz is conducted to evaluate the changes in cerebral edema. We proposed an Amplitude-based Characteristic Parameter Extraction (Ab-CPE) algorithm for multi-frequency characteristic analysis over the frequency range of 1–100 MHz and investigated its performance in electromagnetic induction-based cerebral edema detection and distinction of its acute/chronic phase. Fourteen rabbits were enrolled to establish cerebral edema model and the 24 h real-time monitoring experiments were carried out for algorithm verification. Results The proposed Ab-CPE algorithm was able to detect cerebral edema with a sensitivity of 94.1% and specificity of 95.4%. Also, in the early stage, it can detect cerebral edema with a sensitivity of 85.0% and specificity of 87.5%. Moreover, the Ab-CPE algorithm was able to distinguish between acute and chronic phase of cerebral edema with a sensitivity of 85.0% and specificity of 91.0%. Conclusion The proposed Ab-CPE algorithm is suitable for multi-frequency characteristic analysis. Combined with this algorithm, the electromagnetic induction method has an excellent performance on the detection and monitoring of cerebral edema.
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Affiliation(s)
- Jingbo Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gen Li
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China.
| | - Huayou Liang
- China Aerodynamics Research and Development Center Low Speed Aerodynamic Institute, Mianyang, Sichuan, China
| | - Shuanglin Zhao
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jian Sun
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mingxin Qin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China.
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27
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Shahrestani S, Wishart D, Han SMJ, Strickland BA, Bakhsheshian J, Mack WJ, Toga AW, Sanossian N, Tai YC, Zada G. A systematic review of next-generation point-of-care stroke diagnostic technologies. Neurosurg Focus 2021; 51:E11. [PMID: 34198255 DOI: 10.3171/2021.4.focus21122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stroke is a leading cause of morbidity and mortality. Current diagnostic modalities include CT and MRI. Over the last decade, novel technologies to facilitate stroke diagnosis, with the hope of shortening time to treatment and reducing rates of morbidity and mortality, have been developed. The authors conducted a systematic review to identify studies reporting on next-generation point-of-care stroke diagnostic technologies described within the last decade. METHODS A systematic review was performed according to PRISMA guidelines to identify studies reporting noninvasive stroke diagnostics. The QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool was utilized to assess risk of bias. PubMed, Web of Science, and Scopus databases were utilized. Primary outcomes assessed included accuracy and timing compared with standard imaging, potential risks or complications, potential limitations, cost of the technology, size/portability, and range/size of detection. RESULTS Of the 2646 reviewed articles, 19 studies met the inclusion criteria and included the following modalities of noninvasive stoke detection: microwave technology (6 studies, 31.6%), electroencephalography (EEG; 4 studies, 21.1%), ultrasonography (3 studies, 15.8%), near-infrared spectroscopy (NIRS; 2 studies, 10.5%), portable MRI devices (2 studies, 10.5%), volumetric impedance phase-shift spectroscopy (VIPS; 1 study, 5.3%), and eddy current damping (1 study, 5.3%). Notable medical devices that accurately predicted stroke in this review were EEG-based diagnosis, with a maximum sensitivity of 91.7% for predicting a stroke, microwave-based diagnosis, with an area under the receiver operating characteristic curve (AUC) of 0.88 for differentiating ischemic stroke and intracerebral hemorrhage (ICH), ultrasound with an AUC of 0.92, VIPS with an AUC of 0.93, and portable MRI with a diagnostic accuracy similar to that of traditional MRI. NIRS offers significant potential for more superficially located hemorrhage but is limited in detecting deep-seated ICH (2.5-cm scanning depth). CONCLUSIONS As technology and computational resources have advanced, several novel point-of-care medical devices show promise in facilitating rapid stroke diagnosis, with the potential for improving time to treatment and informing prehospital stroke triage.
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Affiliation(s)
- Shane Shahrestani
- Departments of1Neurological Surgery and.,2Department of Medical Engineering, California Institute of Technology, Pasadena; and
| | | | | | | | | | | | - Arthur W Toga
- 3Laboratory of NeuroImaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nerses Sanossian
- 4Neurology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Yu-Chong Tai
- 2Department of Medical Engineering, California Institute of Technology, Pasadena; and
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Shahrestani S, Strickland BA, Bakhsheshian J, Mack WJ, Toga AW, Sanossian N, Tai YC, Zada G. Transcranial eddy current damping sensors for detection and imaging of hemorrhagic stroke: feasibility in benchtop experimentation. Neurosurg Focus 2021; 51:E15. [PMID: 34198251 DOI: 10.3171/2021.4.focus21121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spontaneous intracerebral hemorrhage occurs in an estimated 10% of stroke patients, with high rates of associated mortality. Portable diagnostic technologies that can quickly and noninvasively detect hemorrhagic stroke may prevent unnecessary delay in patient care and help rapidly triage patients with ischemic versus hemorrhagic stroke. As such, the authors aimed to develop a rapid and portable eddy current damping (ECD) hemorrhagic stroke sensor for proposed in-field diagnosis of hemorrhagic stroke. METHODS A tricoil ECD sensor with microtesla-level magnetic field strengths was constructed. Sixteen gelatin brain models with identical electrical properties to live brain tissue were developed and placed within phantom skull replicas, and saline was diluted to the conductivity of blood and placed within the brain to simulate a hemorrhage. The ECD sensor was used to detect modeled hemorrhages on benchtop models. Data were saved and plotted as a filtered heatmap to represent the lesion location. The individuals performing the scanning were blinded to the bleed location, and sensors were tangentially rotated around the skull models to localize blood. Data were also used to create heatmap images using MATLAB software. RESULTS The sensor was portable (11.4-cm maximum diameter), compact, and cost roughly $100 to manufacture. Scanning time was 2.43 minutes, and heatmap images of the lesion were produced in near real time. The ECD sensor accurately predicted the location of a modeled hemorrhage in all (n = 16) benchtop experiments with excellent spatial resolution. CONCLUSIONS Benchtop experiments demonstrated the proof of concept of the ECD sensor for rapid transcranial hemorrhagic stroke diagnosis. Future studies with live human participants are warranted to fully establish the feasibility findings derived from this study.
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Affiliation(s)
- Shane Shahrestani
- Departments of1Neurological Surgery and.,2Department of Medical Engineering, California Institute of Technology, Pasadena, California
| | | | | | | | - Arthur W Toga
- 3Laboratory of NeuroImaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles; and
| | | | - Yu-Chong Tai
- 2Department of Medical Engineering, California Institute of Technology, Pasadena, California
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29
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Large Vessel Occlusion Stroke Detection in the Prehospital Environment. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021; 9:64-72. [PMID: 36204242 PMCID: PMC9534324 DOI: 10.1007/s40138-021-00234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review Endovascular therapy for acute ischemic stroke secondary to large vessel occlusion (LVO) is time-dependent. Prehospital patients with suspected LVO stroke should be triaged directly to specialized stroke centers for endovascular therapy. This review describes advances in LVO detection among prehospital suspected stroke patients. Recent Findings Clinical prehospital stroke severity tools have been validated in the prehospital setting. Devices including EEG, SSEPs, TCD, cranial accelerometry, and volumetric impedance phase-shift-spectroscopy have recently published data regarding LVO detection in hospital settings. Mobile stroke units bring thrombolysis and vessel imaging to patients. Summary The use of a prehospital stroke severity tool for LVO triage is now widely supported. Ease of use should be prioritized as there are no meaningful differences in diagnostic performance amongst tools. LVO diagnostic devices are promising, but none have been validated in the prehospital setting. Mobile stroke units improve patient outcomes and cost-effectiveness analyses are underway.
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30
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Shahrestani S, Zada G, Chou TC, Toy B, Yao B, Garrett N, Sanossian N, Brunswick A, Shang KM, Tai YC. Noninvasive transcranial classification of stroke using a portable eddy current damping sensor. Sci Rep 2021; 11:10297. [PMID: 33986450 PMCID: PMC8119677 DOI: 10.1038/s41598-021-89735-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/30/2021] [Indexed: 12/02/2022] Open
Abstract
Existing paradigms for stroke diagnosis typically involve computed tomography (CT) imaging to classify ischemic versus hemorrhagic stroke variants, as treatment for these subtypes varies widely. Delays in diagnosis and transport of unstable patients may worsen neurological status. To address these issues, we describe the development of a rapid, portable, and accurate eddy current damping (ECD) stroke sensor. Copper wire was wound to create large (11.4 cm), medium (4.5 cm), and small (1.5 cm) solenoid coils with varying diameters, with each connected to an inductance-to-digital converter. Eight human participants were recruited between December 15, 2019 and March 15, 2020, including two hemorrhagic stroke, two ischemic stroke, one subarachnoid hemorrhage, and three control participants. Observers were blinded to lesion type and location. A head cap with 8 horizontal scanning paths was placed on the patient. The sensor was tangentially rotated across each row on the patient’s head circumferentially. Consent, positioning, and scanning with the sensor took roughly 15 min from start to end for each participant and all scanning took place at the patient bedside. The ECD sensor accurately classified and imaged each of the varying stroke types in each patient. The sensor additionally detected ischemic and hemorrhagic lesions located deep inside the brain, and its range is selectively tunable during sensor design and fabrication.
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Affiliation(s)
- Shane Shahrestani
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA. .,Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tzu-Chieh Chou
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Brandon Toy
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Bryan Yao
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Norman Garrett
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nerses Sanossian
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Brunswick
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kuang-Ming Shang
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Yu-Chong Tai
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA
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31
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van Meenen LCC, van Stigt MN, Siegers A, Smeekes MD, van Grondelle JAF, Geuzebroek G, Marquering HA, Majoie CBLM, Roos YBWEM, Koelman JHTM, Potters WV, Coutinho JM. Detection of Large Vessel Occlusion Stroke in the Prehospital Setting: Electroencephalography as a Potential Triage Instrument. Stroke 2021; 52:e347-e355. [PMID: 33940955 DOI: 10.1161/strokeaha.120.033053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A reliable and fast instrument for prehospital detection of large vessel occlusion (LVO) stroke would be a game-changer in stroke care, because it would enable direct transportation of LVO stroke patients to the nearest comprehensive stroke center for endovascular treatment. This strategy would substantially improve treatment times and thus clinical outcomes of patients. Here, we outline our view on the requirements of an effective prehospital LVO detection method, namely: high diagnostic accuracy; fast application and interpretation; user-friendliness; compactness; and low costs. We argue that existing methods for prehospital LVO detection, including clinical scales, mobile stroke units and transcranial Doppler, do not fulfill all criteria, hindering broad implementation of these methods. Instead, electroencephalography may be suitable for prehospital LVO detection since in-hospital studies have shown that quantification of hypoxia-induced changes in the electroencephalography signal have good diagnostic accuracy for LVO stroke. Although performing electroencephalography measurements in the prehospital setting comes with challenges, solutions for fast and simple application of this method are available. Currently, the feasibility and diagnostic accuracy of electroencephalography in the prehospital setting are being investigated in clinical trials.
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Affiliation(s)
- Laura C C van Meenen
- Department of Neurology (L.C.C.v.M., Y.B.W.E.M.R., W.V.P., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Maritta N van Stigt
- Department of Clinical Neurophysiology (M.N.v.S., J.H.T.M.K., W.V.P.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Arjen Siegers
- Ambulance Amsterdam, Amsterdam, the Netherlands (A.S., J.A.F.v.G., G.G.)
| | - Martin D Smeekes
- Emergency Medical Services North-Holland North, Alkmaar, the Netherlands (M.D.S.)
| | | | - Geertje Geuzebroek
- Ambulance Amsterdam, Amsterdam, the Netherlands (A.S., J.A.F.v.G., G.G.)
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC, University of Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine (H.A.M., C.B.L.M.M.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine (H.A.M., C.B.L.M.M.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Yvo B W E M Roos
- Department of Neurology (L.C.C.v.M., Y.B.W.E.M.R., W.V.P., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Johannes H T M Koelman
- Department of Clinical Neurophysiology (M.N.v.S., J.H.T.M.K., W.V.P.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Wouter V Potters
- Department of Neurology (L.C.C.v.M., Y.B.W.E.M.R., W.V.P., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands.,Department of Clinical Neurophysiology (M.N.v.S., J.H.T.M.K., W.V.P.), Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jonathan M Coutinho
- Department of Neurology (L.C.C.v.M., Y.B.W.E.M.R., W.V.P., J.M.C.), Amsterdam UMC, University of Amsterdam, the Netherlands
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32
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Sergot PB, Maza AJ, Derrick BJ, Smith LM, Berti LT, Wilcox MR, Kesinger MR, Peacock WF. Portable Neuromonitoring Device Detects Large Vessel Occlusion in Suspected Acute Ischemic Stroke. Stroke 2021; 52:1437-1440. [PMID: 33596672 DOI: 10.1161/strokeaha.120.031225] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Early detection of large vessel occlusion (LVO) stroke optimizes endovascular therapy and improves outcomes. Clinical stroke severity scales used for LVO identification have variable accuracy. We investigated a portable LVO-detection device (PLD), using electroencephalography and somatosensory-evoked potentials, to identify LVO stroke. METHODS We obtained PLD data in suspected patients with stroke enrolled prospectively via a convenience sample in 8 emergency departments within 24 hours of symptom onset. LVO discriminative signals were integrated into a binary classifier. The National Institutes of Health Stroke Scale was documented, and 4 prehospital stroke scales were retrospectively calculated. We compared PLD and scale performance to diagnostic neuroimaging. RESULTS Of 109 patients, there were 25 LVO (23%), 38 non-LVO ischemic (35%), 14 hemorrhages (13%), and 32 stroke mimics (29%). The PLD had higher sensitivity (80% [95% CI, 74-85]) and similar specificity (80% [95% CI, 77-83]) to all prehospital scales at their predetermined high probability LVO thresholds. The PLD had high discrimination for LVO (C-statistic=0.88). CONCLUSIONS The PLD identifies LVO with superior accuracy compared with prehospital stroke scales in emergency department suspected stroke. Future studies need to validate the PLD's potential as an LVO triage aid in prehospital undifferentiated stroke populations.
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Affiliation(s)
- Paulina B Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX (P.B.S.)
| | - Andrew J Maza
- Forest Devices, Inc, Pittsburgh, PA (A.J.M., L.T.B., M.R.W., M.R.K., W.F.P.)
| | - Bruce J Derrick
- Division of Emergency Medicine, Duke University Medical Center, Durham, NC (B.J.D.)
| | - Lane M Smith
- Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (L.M.S.)
| | - Liam T Berti
- Forest Devices, Inc, Pittsburgh, PA (A.J.M., L.T.B., M.R.W., M.R.K., W.F.P.)
| | - Madeleine R Wilcox
- Forest Devices, Inc, Pittsburgh, PA (A.J.M., L.T.B., M.R.W., M.R.K., W.F.P.)
| | - Matthew R Kesinger
- Forest Devices, Inc, Pittsburgh, PA (A.J.M., L.T.B., M.R.W., M.R.K., W.F.P.)
| | - W Frank Peacock
- Forest Devices, Inc, Pittsburgh, PA (A.J.M., L.T.B., M.R.W., M.R.K., W.F.P.).,Department of Emergency Medicine, Baylor College of Medicine, Houston, TX (W.F.P.)
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Bai Z, Li H, Chen J, Zhuang W, Li G, Chen M, Xu J, Zhao S, Liu Y, Sun J, Wang F, Xu L, Qin M, Jin G. Research on the measurement of intracranial hemorrhage in rabbits by a parallel-plate capacitor. PeerJ 2021; 9:e10583. [PMID: 33505798 PMCID: PMC7792518 DOI: 10.7717/peerj.10583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022] Open
Abstract
Intracranial hemorrhage (ICH) carrying extremely high morbidity and mortality can only be detected by CT, MRI and other large equipment, which do not meet the requirements for bedside continuous monitoring and pre-hospital first aid. Since the biological tissues have different dielectric properties except the pure resistances, and the permittivity of blood is far larger than that of other brain tissues, here a new method was used to detect events of change at the blood/tissue volume ratio by measuring of the head permittivity. In this paper, we use a self-made parallel plate capacitor to detect the intracranial hemorrhage in rabbits by contactless capacitance measurement. The sensitivity of the parallel-plate capacitor was also evaluated by the physical solution measurement. The results of physical experiments show that the capacitor can distinguish between three solutions with different permittivity, and the capacitance increased with the increase of one solution between two plates. At the next step in the animal experiment, the capacitance changes caused by 2 ml blood injection into the rabbit brain were measured. The results of animal experiments show that the capacitance was almost unchanged before and after the blood injection, but increased with the increase of the blood injection volume. The increase of capacitance caused by blood injection was much larger than that before and after blood injection (P < 0.01). The experiments show that this method is feasible for the detection of intracranial hemorrhage in a non-invasive and contactless manner.
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Affiliation(s)
- Zelin Bai
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haocheng Li
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingbo Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Zhuang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gen Li
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Mingsheng Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jia Xu
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shuanglin Zhao
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuening Liu
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jian Sun
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Feng Wang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lin Xu
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mingxin Qin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gui Jin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
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Li G, Li W, Chen J, Zhao S, Bai Z, Liu Q, Liao Q, He M, Zhuang W, Chen M, Sun J, Chen Y. Noninvasive real-time assessment of intracranial pressure after traumatic brain injury based on electromagnetic coupling phase sensing technology. BMC Neurol 2021; 21:26. [PMID: 33455585 PMCID: PMC7812649 DOI: 10.1186/s12883-021-02049-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/07/2021] [Indexed: 12/16/2022] Open
Abstract
Background To investigate the feasibility of intracranial pressure (ICP) monitoring after traumatic brain injury (TBI) by electromagnetic coupling phase sensing, we established a portable electromagnetic coupling phase shift (ECPS) test system and conducted a comparison with invasive ICP. Methods TBI rabbits’ model were all synchronously monitored for 24 h by ECPS testing and invasive ICP. We investigated the abilities of the ECPS to detect targeted ICP by feature extraction and traditional classification decision algorithms. Results The ECPS showed an overall downward trend with a variation range of − 13.370 ± 2.245° as ICP rose from 11.450 ± 0.510 mmHg to 38.750 ± 4.064 mmHg, but its change rate gradually declined. It was greater than 1.5°/h during the first 6 h, then decreased to 0.5°/h and finally reached the minimum of 0.14°/h. Nonlinear regression analysis results illustrated that both the ECPS and its change rate decrease with increasing ICP post-TBI. When used as a recognition feature, the ability (area under the receiver operating characteristic curve, AUCs) of the ECPS to detect ICP ≥ 20 mmHg was 0.88 ± 0.01 based on the optimized adaptive boosting model, reaching the advanced level of current noninvasive ICP assessment methods. Conclusions The ECPS has the potential to be used for noninvasive continuous monitoring of elevated ICP post-TBI. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02049-3.
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Affiliation(s)
- Gen Li
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China.,Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Wang Li
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Jingbo Chen
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Shuanglin Zhao
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Zelin Bai
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Qi Liu
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Qi Liao
- Department of Biomedical Engineering, School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Minglian He
- Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China.,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China.,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China
| | - Wei Zhuang
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Mingsheng Chen
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China
| | - Jian Sun
- Department of Biomedical Engineering, Army Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China. .,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China.
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University, 29 Gaotanyan Street, Shapingba District, Chongqing, 400038, China. .,State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Chongqing, China. .,Chongqing Key Laboratory of Precision Neuromedicine and Neuroregenaration, Army Medical University, Chongqing, China.
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35
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Oziel M, Rubinsky B, Korenstein R. Detection and estimating the blood accumulation volume of brain hemorrhage in a human anatomical skull using a RF single coil. PeerJ 2020; 8:e10416. [PMID: 33354419 PMCID: PMC7733650 DOI: 10.7717/peerj.10416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/02/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE An experimental study for testing a simple robust algorithm on data derived from an electromagnetic radiation device that can detect small changes in the tissue/fluid ratio in a realistic head configuration. METHODS Changes in the scattering parameters (S21) of an inductive coil resulting from injections of chicken blood in the 0-18 ml range into calf brain tissue in a human anatomical skull were measured over a 100-1,000 MHz frequency range. RESULTS An algorithm that combines amplitude and phase results was found to detect changes in the tissue/fluid ratio with 90% accuracy. An algorithm that estimated the injected blood volume was found to have a 1-4 ml average error. This demonstrates the possibility of the inductive coil-based device to possess a practical ability to detect a change in the tissue/fluid ratio in the head. SIGNIFICANCE This study is an important step towards the goal of building an inexpensive and safe device that can detect an early brain hemorrhagic stroke.
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Affiliation(s)
- Moshe Oziel
- Department of Physiology and Pharmacology, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Rubinsky
- Department of Mechanical Engineering, University of California, Berkeley, Berkeley, CA, USA
| | - Rafi Korenstein
- Department of Physiology and Pharmacology, Tel-Aviv University, Tel-Aviv, Israel
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36
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Xu J, Chen J, Yu W, Zhang H, Wang F, Zhuang W, Yang J, Bai Z, Xu L, Sun J, Jin G, Nian Y, Qin M, Chen M. Noninvasive and portable stroke type discrimination and progress monitoring based on a multichannel microwave transmitting-receiving system. Sci Rep 2020; 10:21647. [PMID: 33303768 PMCID: PMC7728752 DOI: 10.1038/s41598-020-78647-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/25/2020] [Indexed: 01/01/2023] Open
Abstract
The hemorrhagic and the ischemic types of stroke have similar symptoms in the early stage, but their treatments are completely different. The timely and effective discrimination of the two types of stroke can considerable improve the patients' prognosis. In this paper, a 16-channel and noncontact microwave-based stroke detection system was proposed and demonstrated for the potential differentiation of the hemorrhagic and the ischemic stroke. In animal experiments, 10 rabbits were divided into two groups. One group consisted of five cerebral hemorrhage models, and the other group consisted of five cerebral ischemia models. The two groups were monitored by the system to obtain the Euclidean distance transform value of microwave scattering parameters caused by pathological changes in the brain. The support vector machine was used to identify the type and the severity of the stroke. Based on the experiment, a discrimination accuracy of 96% between hemorrhage and ischemia stroke was achieved. Furthermore, the potential of monitoring the progress of intracerebral hemorrhage or ischemia was evaluated. The discrimination of different degrees of intracerebral hemorrhage achieved 86.7% accuracy, and the discrimination of different severities of ischemia achieved 94% accuracy. Compared with that with multiple channels, the discrimination accuracy of the stroke severity with a single channel was only 50% for the intracerebral hemorrhage and ischemia stroke. The study showed that the microwave-based stroke detection system can effectively distinguish between the cerebral hemorrhage and the cerebral ischemia models. This system is very promising for the prehospital identification of the stroke type due to its low cost, noninvasiveness, and ease of operation.
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Affiliation(s)
- Jia Xu
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Jingbo Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Wei Yu
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Haisheng Zhang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Feng Wang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Wei Zhuang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Jun Yang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Zelin Bai
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Lin Xu
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Jian Sun
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Department of Neurosurgery, Southwest Hospital, Chongqing, 400030, People's Republic of China
| | - Gui Jin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Yongjian Nian
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China
| | - Mingxin Qin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China. .,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.
| | - Mingsheng Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China. .,Institute of Brain and Intelligence, Third Military Medical University (Army Medical University), Chongqing, 400030, People's Republic of China.
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37
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Morey JR, Oxley TJ, Wei D, Kellner CP, Dangayach NS, Stein L, Hom D, Wheelwright D, Rubenstein L, Skliut M, Shoirah H, De Leacy RA, Singh IP, Zhang X, Persaud S, Tuhrim S, Dhamoon M, Bederson J, Mocco J, Fifi JT, Boniece IR, Brockington CD, Fara M, Hao Q, Horowitz DR, Lay C, Liang J, Nasrallah EJ, Roche T, Sheinart KF, Paul Singh I, Tegtmeyer C, Weinberger J. Mobile Interventional Stroke Team Model Improves Early Outcomes in Large Vessel Occlusion Stroke. Stroke 2020; 51:3495-3503. [DOI: 10.1161/strokeaha.120.030248] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and Purpose:
Triage of patients with emergent large vessel occlusion stroke to primary stroke centers followed by transfer to comprehensive stroke centers leads to increased time to endovascular therapy. A Mobile Interventional Stroke Team (MIST) provides an alternative model by transferring a MIST to a Thrombectomy Capable Stroke Center (TSC) to perform endovascular therapy. Our aim is to determine whether the MIST model is more time-efficient and leads to improved clinical outcomes compared with standard drip-and-ship (DS) and mothership models.
Methods:
This is a prospective observational cohort study with 3-month follow-up between June 2016 and December 2018 at a multicenter health system, consisting of one comprehensive stroke center, 4 TSCs, and several primary stroke centers. A total of 228 of 373 patients received endovascular therapy via 1 of 4 models: mothership with patient presentation to a comprehensive stroke center, DS with patient transfer from primary stroke center or TSC to comprehensive stroke center, MIST with patient presentation to TSC and MIST transfer, or a combination of DS with patient transfer from primary stroke center to TSC and MIST. The prespecified primary end point was initial door-to-recanalization time and secondary end points measured additional time intervals and clinical outcomes at discharge and 3 months.
Results:
MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes (
P
<0.01). MIST and mothership had similar median door-to-recanalization times of 192 minutes and 179 minutes, respectively (
P
=0.83). A greater proportion had a complete recovery (National Institutes of Health Stroke Scale of 0 or 1) at discharge in MIST compared with DS (37.9% versus 16.7%;
P
<0.01). MIST had 52.8% of patients with modified Rankin Scale of ≤2 at 3 months compared with 38.9% in DS (
P
=0.10).
Conclusions:
MIST led to significantly faster initial door-to-recanalization times compared with DS, which was comparable to mothership. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03048292.
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Affiliation(s)
- Jacob R. Morey
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - Thomas J. Oxley
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - Daniel Wei
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Christopher P. Kellner
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - Neha S. Dangayach
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Laura Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Danny Hom
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - Danielle Wheelwright
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Liorah Rubenstein
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - Maryna Skliut
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Hazem Shoirah
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Reade A. De Leacy
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - I. Paul Singh
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Xiangnan Zhang
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - Steven Persaud
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - Stanley Tuhrim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
| | - Joshua Bederson
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - J Mocco
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
| | - Johanna T. Fifi
- Department of Neurosurgery (J.R.M., T.J.O., D.W., C.P.K., N.S.D., D.H., L.R., H.S., R.A.D.L., I.P.S., X.Z., S.P., J.B., J.M., J.T.F.)
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY (N.S.D., L.S., D.W., M.S., H.S., I.P.S., S.T., M.D., J.T.F.)
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The Neurological Examination Improves Cranial Accelerometry Large Vessel Occlusion Prediction Accuracy. Neurocrit Care 2020; 35:103-112. [PMID: 33215393 DOI: 10.1007/s12028-020-01144-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVE We combined cranial accelerometry, a device-based approach to large vessel occlusion (LVO) prediction, with neurological examination findings to determine if this improves diagnostic accuracy compared to either alone. METHODS Cranial accelerometry recordings and NIHSS scores were obtained during stroke codes and thrombectomy transfers at an academic medical center using convenience sampling. The reference standard was discharge diagnosis of LVO stroke. We compared accuracy statistics between machine learning models trained using cranial accelerometry alone, with asymmetric arm weakness added, with NIHSS scores added, and retrospective examination only LVO prediction scales. An exploratory analysis required asymmetric arm weakness prior to model training or scale testing. RESULTS Of 68 patients, there were 23 LVO strokes. Cranial accelerometry was 65% sensitive (95% CI 43-84%) and 87% specific (95% CI 73-95%). Adding asymmetric arm weakness increased specificity to 91% (95% CI 79-98%). Adding asymmetric arm weakness and the NIHSS increased sensitivity to 74% (95% CI 52-90%) and decreased specificity to 89% (95% CI 76-96%). LVO prediction scales had wide sensitivity and specificity ranges. The exploratory analysis improved sensitivity to 91% (95% CI 72-99%) and specificity to 93% (95% CI 92-99%) with only three false positives and two false negatives. CONCLUSIONS Cranial accelerometry models are improved by various additions of asymmetric arm weakness and the NIHSS. An exploratory analysis requiring asymmetric arm weakness prior to cranial accelerometry model training minimized false positives and negatives.
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39
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Maas WJ, Lahr MMH, Buskens E, van der Zee DJ, Uyttenboogaart M. Pathway Design for Acute Stroke Care in the Era of Endovascular Thrombectomy: A Critical Overview of Optimization Efforts. Stroke 2020; 51:3452-3460. [PMID: 33070713 DOI: 10.1161/strokeaha.120.030392] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The efficacy of intravenous thrombolysis and endovascular thrombectomy (EVT) for acute ischemic stroke is highly time dependent. Optimal organization of acute stroke care is therefore important to reduce treatment delays but has become more complex after the introduction of EVT as regular treatment for large vessel occlusions. There is no singular optimal organizational model that can be generalized to different geographic regions worldwide. Current dominant organizational models for EVT include the drip-and-ship- and mothership model. Guidelines recommend routing of suspected patients with stroke to the nearest intravenous thrombolysis capable facility; however, the choice of routing to a certain model should depend on regional stroke service organization and individual patient characteristics. In general, design approaches for organizing stroke care are required, in which 2 key strategies could be considered. The first entails the identification of interventions within existing organizational models for optimizing timely delivery of intravenous thrombolysis and/or EVT. This includes adaptive patient routing toward a comprehensive stroke center, which focuses particularly on prehospital triage tools; bringing intravenous thrombolysis or EVT to the location of the patient; and expediting services and processes along the stroke pathway. The second strategy is to develop analytical or simulation model-based approaches enabling the design and evaluation of organizational models before their implementation. Organizational models for acute stroke care need to take regional and patient characteristics into account and can most efficiently be assessed and optimized through the application of model-based approaches.
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Affiliation(s)
- Willemijn J Maas
- Department of Neurology (W.J.M., M.U.), University of Groningen, University Medical Center Groningen, the Netherlands.,Department of Epidemiology, Health Technology Assessment unit (W.J.M., M.M.H.L., E.B.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Maarten M H Lahr
- Department of Epidemiology, Health Technology Assessment unit (W.J.M., M.M.H.L., E.B.), University of Groningen, University Medical Center Groningen, the Netherlands
| | - Erik Buskens
- Department of Epidemiology, Health Technology Assessment unit (W.J.M., M.M.H.L., E.B.), University of Groningen, University Medical Center Groningen, the Netherlands.,Department of Operations, Faculty of Economics and Business, University of Groningen, the Netherlands (E.B., D.-J.v.d.Z.)
| | - Durk-Jouke van der Zee
- Department of Operations, Faculty of Economics and Business, University of Groningen, the Netherlands (E.B., D.-J.v.d.Z.)
| | - Maarten Uyttenboogaart
- Department of Neurology (W.J.M., M.U.), University of Groningen, University Medical Center Groningen, the Netherlands.,Department of Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands
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Chen J, Li G, Chen M, Jin G, Zhao S, Bai Z, Yang J, Liang H, Xu J, Sun J, Qin M. A noninvasive flexible conformal sensor for accurate real-time monitoring of local cerebral edema based on electromagnetic induction. PeerJ 2020; 8:e10079. [PMID: 33083136 PMCID: PMC7546241 DOI: 10.7717/peerj.10079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022] Open
Abstract
Cerebral edema (CE) is a non-specific pathological swelling of the brain secondary to any type of neurological injury. The real-time monitoring of focal CE mostly found in early stage is of great significance to reduce mortality and disability. Magnetic Induction Phase Shift (MIPS) is expected to achieve non-invasive continuous monitoring of CE. However, most existing MIPS sensors are made of hard materials which makes it difficult to accurately retrieve CE information. In this article, we designed a conformal two-coil structure and a single-coil structure, and studied their sensitivity map using finite element method (FEM). After that, the conformal MIPS sensor that is preferable for local CE monitoring was fabricated by flexible printed circuit (FPC). Next, physical experiments were conducted to investigate its performance on different levels of simulated CE solution volume, measurement distance, and bending. Subsequently, 14 rabbits were chosen to establish CE model and another three rabbits were selected as controls. The 24-hour MIPS real-time monitoring experiments was carried out to verify that the feasibility. Results showed a gentler attenuation trend of the conformal two-coil structure, compared with the single-coil structure. In addition, the novel flexible conformal MIPS sensor has a characteristic of being robust to bending according to the physical experiments. The results of animal experiments showed that the sensor can be used for CE monitoring. It can be concluded that this flexible conformal MIPS sensor is desirable for local focusing measurement of CE and subsequent multidimensional information extraction for predicting model. Also, it enables a much more comfortable environment for long-time bedside monitoring.
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Affiliation(s)
- Jingbo Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gen Li
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China
| | - Mingsheng Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gui Jin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shuanglin Zhao
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zelin Bai
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jun Yang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huayou Liang
- China Aerodynamics Research and Development Center Low Speed Aerodynamic Institute, Mianyang, China
| | - Jia Xu
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jian Sun
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Neurosurgery, Southwest Hospital, Chongqing, China
| | - Mingxin Qin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
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Simpkins AN, Janowski M, Oz HS, Roberts J, Bix G, Doré S, Stowe AM. Biomarker Application for Precision Medicine in Stroke. Transl Stroke Res 2020; 11:615-627. [PMID: 31848851 PMCID: PMC7299765 DOI: 10.1007/s12975-019-00762-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/25/2022]
Abstract
Stroke remains one of the leading causes of long-term disability and mortality despite recent advances in acute thrombolytic therapies. In fact, the global lifetime risk of stroke in adults over the age of 25 is approximately 25%, with 24.9 million cases of ischemic stroke and 18.7 million cases of hemorrhagic stroke reported in 2015. One of the main challenges in developing effective new acute therapeutics and enhanced long-term interventions for stroke recovery is the heterogeneity of stroke, including etiology, comorbidities, and lifestyle factors that uniquely affect each individual stroke survivor. In this comprehensive review, we propose that future biomarker studies can be designed to support precision medicine therapeutic interventions after stroke. The current challenges in defining ideal biomarkers for stroke are highlighted, including consideration of disease course, age, lifestyle factors, and subtypes of stroke. This overview of current clinical trials includes biomarker collection, and concludes with an example of biomarker design for aneurysmal subarachnoid hemorrhage. With the advent of "-omics" studies, neuroimaging, big data, and precision medicine, well-designed stroke biomarker trials will greatly advance the treatment of a disease that affects millions globally every year.
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Affiliation(s)
- Alexis N Simpkins
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Miroslaw Janowski
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Helieh S Oz
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Jill Roberts
- Department of Neurosurgery, University of Kentucky, Lexington, KY, USA
- Center for Advanced Translational Stroke Science, Lexington, KY, USA
| | - Gregory Bix
- Clinical Neuroscience Research Center, Tulane University, New Orleans, LA, USA
- Department of Neurosurgery, Neurology, Tulane University, New Orleans, LA, USA
| | - Sylvain Doré
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
- Department of Neurology, Psychiatry, Pharmaceutics, Neuroscience, University of Florida, Gainesville, FL, USA
| | - Ann M Stowe
- Center for Advanced Translational Stroke Science, Lexington, KY, USA.
- Department of Neurology, University of Kentucky, Lexington, KY, USA.
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Lumley HA, Flynn D, Shaw L, McClelland G, Ford GA, White PM, Price CI. A scoping review of pre-hospital technology to assist ambulance personnel with patient diagnosis or stratification during the emergency assessment of suspected stroke. BMC Emerg Med 2020; 20:30. [PMID: 32336270 PMCID: PMC7183583 DOI: 10.1186/s12873-020-00323-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pre-hospital identification of key subgroups within the suspected stroke population could reduce delays to emergency treatment. We aimed to identify and describe technology with existing proof of concept for diagnosis or stratification of patients in the pre-hospital setting. METHODS A systematic electronic search of published literature (from 01/01/2000 to 06/06/2019) was conducted in five bibliographic databases. Two reviewers independently assessed eligibility of studies or study protocols describing diagnostic/stratification tests (portable imaging/biomarkers) or technology facilitating diagnosis/stratification (telemedicine) used by ambulance personnel during the assessment of suspected stroke. Eligible descriptions required use of tests or technology during the actual assessment of suspected stroke to provide information directly to ambulance personnel in the pre-hospital setting. Due to study, intervention and setting heterogeneity there was no attempt at meta-analysis. RESULTS 2887 articles were screened for eligibility, 19 of which were retained. Blood biomarker studies (n = 2) were protocols of prospective diagnostic accuracy studies, one examining purines and the other a panel of known and novel biomarkers for identifying stroke sub-types (versus mimic). No data were yet available on diagnostic accuracy or patient health outcomes. Portable imaging studies (n = 2) reported that an infrared screening device for detecting haemorrhages yielded moderate sensitivity and poor specificity in a small study, whilst a dry-EEG study to detect large vessel occlusion in ischaemic stroke has not yet reported results. Fifteen evaluations of pre-hospital telemedicine were identified (12 observational and 3 controlled comparisons) which all involved transmission of stroke assessment data from the pre-hospital setting to the hospital. Diagnosis was generally comparable with hospital diagnosis and most telemedicine systems reduced time-to-treatment; however, it is unknown whether this time saving translated into more favourable clinical outcomes. Telemedicine systems were deemed acceptable by clinicians. CONCLUSIONS Pre-hospital technologies to identify clinically important subgroups amongst the suspected stroke population are in development but insufficient evidence precludes recommendations about routine use in the pre-hospital setting. Multi-centre diagnostic accuracy studies and clinical utility trials combining promising technologies are warranted.
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Affiliation(s)
- Hannah A Lumley
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- School of Health and Social Care, Teesside University, Tees Valley, UK
| | - Lisa Shaw
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Graham McClelland
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- North East Ambulance Service NHS Foundation Trust, Newcastle upon Tyne, England
| | - Gary A Ford
- Medical Sciences Division, Oxford Academic Health Science Network, University of Oxford, and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Phil M White
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England
| | - Christopher I Price
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, England
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43
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Yaeger KA, Shoirah H, Kellner CP, Fifi J, Mocco J. Emerging Technologies in Optimizing Pre-Intervention Workflow for Acute Stroke. Neurosurgery 2020; 85:S9-S17. [PMID: 31197335 DOI: 10.1093/neuros/nyz058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
Over the last several years, thrombectomy for large vessel occlusions (LVOs) has emerged as a standard of care for acute stroke patients. Furthermore, the time to reperfusion has been identified as a predictor of overall patient outcomes, and much effort has been made to identify potential areas to target in enhancing preintervention workflow. As medical technology and stroke devices improve, nearly all time points can be affected, from field stroke triage to automated imaging interpretation to mass mobile stroke code communications. In this article, we review the preintervention stroke workflow with specific regard to emerging technologies in improving time to reperfusion and overall patient outcomes.
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Affiliation(s)
- Kurt A Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| | - Hazem Shoirah
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| | - Johanna Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai Medical System, New York, New York
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Rindler RS, Allen JW, Barrow JW, Pradilla G, Barrow DL. Neuroimaging of Intracerebral Hemorrhage. Neurosurgery 2020; 86:E414-E423. [DOI: 10.1093/neuros/nyaa029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/28/2019] [Indexed: 02/05/2023] Open
Abstract
AbstractIntracerebral hemorrhage (ICH) accounts for 10% to 20% of strokes worldwide and is associated with high morbidity and mortality rates. Neuroimaging is indispensable for rapid diagnosis of ICH and identification of the underlying etiology, thus facilitating triage and appropriate treatment of patients. The most common neuroimaging modalities include noncontrast computed tomography (CT), CT angiography (CTA), digital subtraction angiography, and magnetic resonance imaging (MRI). The strengths and disadvantages of each modality will be reviewed. Novel technologies such as dual-energy CT/CTA, rapid MRI techniques, near-infrared spectroscopy, and automated ICH detection hold promise for faster pre- and in-hospital ICH diagnosis that may impact patient management.
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Affiliation(s)
- Rima S Rindler
- Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, Georgia
| | - Jack W Barrow
- Mercer University School of Medicine, Savannah, Georgia
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia
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45
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Price CI, Shaw L, Dixit A, Graziadio S, Lendrem C, Mitra D, Rodgers H, Sutcliffe L, White P. Asymmetrical Bioimpedance in the Anterior Circulation for Urgent Stratification of suspected Stroke (ABACUS Stroke): study protocol for a diagnostic accuracy study. Diagn Progn Res 2020; 4:2. [PMID: 32110739 PMCID: PMC7033905 DOI: 10.1186/s41512-019-0068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Early identification and treatment of stroke improve outcome. Ischaemic stroke due to large vessel occlusion (LVO) benefits from time-critical thrombectomy but this is only available in highly specialised healthcare services. Cerebral Bioimpedance Asymmetry (CBA) measurement obtained with the portable and rapid Cerebrotech Visor™ System device may be able to identify certain types of stroke including LVO. This test could be deployed pre-hospital and used to immediately direct patients to the most appropriate healthcare service for treatment. This study is evaluating the diagnostic accuracy of CBA measurements obtained from a real-world population of suspected stroke. METHODS Study design: Prospective observational cohort study.Setting: A hyperacute stroke unit and neuroscience centre in North East England.Participants: Adults with a paramedic assigned diagnosis of suspected stroke arriving at hospital within 6 hours of symptom onset.Index Test: Cerebral Bioimpedance Asymmetry measurement performed using the Cerebrotech Visor™ System. Measurement values produce continuous data (range 0 -100); pre-defined threshold for positive state ≥ 10.Reference Standard Tests: Standard CT brain +/- CT/MR angiography, and expert clinician opinion will establish the following clinical outcomes which constitute the suspected stroke population: ischaemic stroke +/- large vessel occlusion; symptomatic severe anterior vessel stenosis; large (≥60ml) and small (<60mls) vessel intracerebral haemorrhage; transient ischaemic attack; stroke mimic conditions; prior territorial stroke.Analyses: Sensitivity, specificity, negative and positive predictive values, area under the Receiver Operating Characteristic curve for identification of i) "complex stroke" (ischaemic stroke with large vessel occlusion or symptomatic severe anterior vessel stenosis or intracerebral haemorrhage ≥60ml or prior territorial stroke) and ii) ischaemic stroke with large vessel occlusion in isolation.Sample size: 124 participants. DISCUSSION The results from this study will determine how accurately CBA measurement using the Cerebrotech Visor™ System can identify key stroke types within the suspected stroke population. Acceptable diagnostic performance would be an important step forwards for access to time-critical treatments. TRIAL REGISTRATION Registered with ISRCTN (identifier: ISRCTN79169844) on 06/08/2018.
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Affiliation(s)
- Christopher I. Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Anand Dixit
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Sara Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, Room M2.061, William Leech Building, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Clare Lendrem
- NIHR Newcastle In Vitro Diagnostics Co-operative, Room M2.061, William Leech Building, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Dipayan Mitra
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - Lou Sutcliffe
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
| | - Phil White
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Henry Wellcome Building, Framlington Place, Newcastle upon Tyne, NE2 4HH UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Hospital, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
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Oziel M, Korenstein R, Rubinsky B. A Brain Phantom Study of a Noncontact Single Inductive Coil Device and the Attendant Algorithm for First Stage Diagnosis of Internal Bleeding in the Head. J Med Device 2020. [DOI: 10.1115/1.4045489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Hemorrhagic stroke is one of the leading causes of premature death among economically disadvantaged populations. Treatments of these conditions require an early diagnosis. While computed tomography and magnetic resonance imaging are the medical gold standard for early diagnosis, these imaging modalities are rarely available in low- and middle-income countries. We present an unsophisticated noncontact single coil inductive device and a simple algorithm for detection of changes in fluid/tissue ratio in the head which simulates blood vessel bursting in the brain. Experiments were performed on a typical phantom model of the head and internal bleeding was simulated by injection of physiological saline at two locations in the head phantom. The primary motivation for this work is the need for a simple and robust detection device and algorithm for diagnosis of hemorrhagic stroke in low- and middle-income countries. This phantom-based study shows that the technology and in particular the algorithm introduced here are robust and could replace conventional imaging for first stage diagnosis of internal bleeding in the head, and thereby save millions of lives every year. Clinical studies are required to further examine the technology and the algorithm.
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Affiliation(s)
- Moshe Oziel
- Department of Physiology and Pharmacology, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Rafi Korenstein
- Department of Physiology and Pharmacology, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Boris Rubinsky
- Department of Mechanical Engineering, University of California Berkeley, Berkeley, CA 94720
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47
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Sweid A, Hammoud B, Ramesh S, Wong D, Alexander TD, Weinberg JH, Deprince M, Dougherty J, Maamari DJM, Tjoumakaris S, Zarzour H, Gooch MR, Herial N, Romo V, Hasan DM, Rosenwasser RH, Jabbour P. Acute ischaemic stroke interventions: large vessel occlusion and beyond. Stroke Vasc Neurol 2019; 5:80-85. [PMID: 32411412 PMCID: PMC7213503 DOI: 10.1136/svn-2019-000262] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/29/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022] Open
Abstract
Care for acute ischaemic stroke is one of the most rapidly evolving fields due to the robust outcomes achieved by mechanical thrombectomy. Large vessel occlusion (LVO) accounts for up to 38% of acute ischaemic stroke and comes with devastating outcomes for patients, families and society in the pre-intervention era. A paradigm shift and a breakthrough brought mechanical thrombectomy back into the spotlight for acute ischaemic stroke; this was because five randomised controlled trials from several countries concluded that mechanical thrombectomy for acute stroke offered overwhelming benefits. This review article will present a comprehensive overview of LVO management, techniques and devices used, and the future of stroke therapy. In addition, we review our institution experience of mechanical thrombectomy for posterior and distal circulation occlusion.
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Affiliation(s)
- Ahmad Sweid
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Batoul Hammoud
- Endocrinology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sunidhi Ramesh
- Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniella Wong
- Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tyler D Alexander
- Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Maureen Deprince
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Jaime Dougherty
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | | | - Hekmat Zarzour
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael R Gooch
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel Herial
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Victor Romo
- Anesthesia, Thomas Jefferson University-Center City Campus, Philadelphia, Pennsylvania, USA
| | - David M Hasan
- Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert H Rosenwasser
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Murray NM, Unberath M, Hager GD, Hui FK. Artificial intelligence to diagnose ischemic stroke and identify large vessel occlusions: a systematic review. J Neurointerv Surg 2019; 12:156-164. [DOI: 10.1136/neurintsurg-2019-015135] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeAcute stroke caused by large vessel occlusions (LVOs) requires emergent detection and treatment by endovascular thrombectomy. However, radiologic LVO detection and treatment is subject to variable delays and human expertise, resulting in morbidity. Imaging software using artificial intelligence (AI) and machine learning (ML), a branch of AI, may improve rapid frontline detection of LVO strokes. This report is a systematic review of AI in acute LVO stroke identification and triage, and characterizes LVO detection software.MethodsA systematic review of acute stroke diagnostic-focused AI studies from January 2014 to February 2019 in PubMed, Medline, and Embase using terms: ‘artificial intelligence’ or ‘machine learning or deep learning’ and ‘ischemic stroke’ or ‘large vessel occlusion’ was performed.ResultsVariations of AI, including ML methods of random forest learning (RFL) and convolutional neural networks (CNNs), are used to detect LVO strokes. Twenty studies were identified that use ML. Alberta Stroke Program Early CT Score (ASPECTS) commonly used RFL, while LVO detection typically used CNNs. Image feature detection had greater sensitivity with CNN than with RFL, 85% versus 68%. However, AI algorithm performance metrics use different standards, precluding ideal objective comparison. Four current software platforms incorporate ML: Brainomix (greatest validation of AI for ASPECTS, uses CNNs to automatically detect LVOs), General Electric, iSchemaView (largest number of perfusion study validations for thrombectomy), and Viz.ai (uses CNNs to automatically detect LVOs, then automatically activates emergency stroke treatment systems).ConclusionsAI may improve LVO stroke detection and rapid triage necessary for expedited treatment. Standardization of performance assessment is needed in future studies.
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Jayaraman MV, Hemendinger ML, Baird GL, Yaghi S, Cutting S, Saad A, Siket M, Madsen TE, Williams K, Rhodes J, Haas RA, Furie KL, McTaggart RA. Field triage for endovascular stroke therapy: a population-based comparison. J Neurointerv Surg 2019; 12:233-239. [DOI: 10.1136/neurintsurg-2019-015033] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/27/2019] [Accepted: 06/29/2019] [Indexed: 11/04/2022]
Abstract
BackgroundEndovascular therapy (EVT) for stroke improves outcomes but is time sensitive.ObjectiveTo compare times to treatment and outcomes between patients taken to the closest primary stroke center (PSC) with those triaged in the field to a more distant comprehensive stroke center (CSC).MethodsDuring the study, a portion of our region allowed field triage of patients who met severity criteria to a more distant CSC than the closest PSC. The remaining patients were transported to the closest PSC. We compared times to treatment and clinical outcomes between those two groups. Additionally, we performed a matched-pairs analysis of patients from both groups on stroke severity and distance to CSC.ResultsOver 2 years, 232 patients met inclusion criteria and were closest from the field to a PSC; 144 were taken to the closest PSC and 88 to the more distant CSC. The median additional transport time to the CSC was 7 min. Times from scene departure to alteplase and arterial puncture were faster in the direct group (50 vs 62 min; 93 vs 152 min; p<0.001 for both). Among patients who were independent before the stroke, the OR for less disability in the direct group was 1.47 (95% CI 1.13 to 1.93, p=0.003), and 2.06 (95% CI 1.10 to 3.89, p=0.01) for the matched pairs.ConclusionsIn a densely populated setting, for patients with stroke who are EVT candidates and closest to a PSC from the field, triage to a slightly more distant CSC is associated with faster time to EVT, no delay to alteplase, and less disability at 90 days.
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50
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Walsh KB. Non-invasive sensor technology for prehospital stroke diagnosis: Current status and future directions. Int J Stroke 2019; 14:592-602. [PMID: 31354081 DOI: 10.1177/1747493019866621] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The diagnosis of stroke in the prehospital environment is the subject of intense interest and research. There are a number of non-invasive external brain monitoring devices in development that utilize various technologies to function as sensors for stroke and other neurological conditions. Future increased use of one or more of these devices could result in substantial changes in the current processes for stroke diagnosis and treatment, including transportation of stroke patients by emergency medical services. AIMS The present review will summarize information about 10 stroke sensor devices currently in development, utilizing various forms of technology, and all of which are external, non-invasive brain monitoring devices. SUMMARY OF REVIEW Ten devices are discussed including the technology utilized, the indications for use (stroke and, when relevant, other neurological conditions), the environment(s) indicated for use (with a focus on the prehospital setting), a description of the physical structure of each instrument, and, when available, findings that have been published in peer-reviewed journals or otherwise reported. The review is organized based on the technology utilized by each device, and seven distinct forms were identified: accelerometers, electroencephalography (EEG), microwaves, near-infrared, radiofrequency, transcranial doppler ultrasound, and volumetric impedance phase shift spectroscopy. CONCLUSIONS Non-invasive external brain monitoring devices are in various stages of development and have promise as stroke sensors in the prehospital setting. Some of the potential applications include to differentiate stroke from non-stroke, ischemic from hemorrhage stroke, and large vessel occlusion (LVO) from non-LVO ischemic stroke. Successful stroke diagnosis prior to hospital arrival could transform the current diagnostic and treatment paradigm for this disease.
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Affiliation(s)
- Kyle B Walsh
- 1 Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.,2 University of Cincinnati Gardner Neuroscience Institute, Cincinnati, OH, USA
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