Stroke is the leading cause of disability worldwide and the second leading cause of death, but appropriate early intervention can prevent serious consequences. A new study led by researchers at Brigham and Women’s Hospital, a founding member of the Mass General Brigham health care system, and collaborators developed a new test combining blood biomarkers with a clinical score to identify patients who suffer a large occlusion stroke. glasses (LVO). with high precision. Their results are published in the journal. Stroke: Vascular and Interventional Neurology.
“We have developed an innovative and accessible tool that could help ensure that more people who suffer a stroke are in the right place at the right time to receive critical, life-restoring care,” said lead author Joshua Bernstock, MD, PhD, MPH, clinical member, Department of Neurosurgery, Brigham and Women’s Hospital.
Most strokes are ischemic, in which blood flow to the brain is blocked. LVO strokes are an aggressive type of ischemic stroke that occurs when a blockage occurs in a major artery in the brain. When blood supply to the brain is compromised, lack of oxygen and nutrients causes brain cells to die within minutes. LVO strokes are major medical emergencies and require prompt treatment with mechanical thrombectomy, a surgical procedure that relieves the obstruction.
“Mechanical thrombectomy has allowed people who would otherwise have died or been significantly disabled to make a full recovery, as if their stroke had never happened,” Bernstock said. “The sooner this intervention is implemented, the better the outcome for the patient. This exciting new technology has the potential to allow more people around the world to receive this treatment faster.”
The research team previously focused on two specific proteins found in capillary blood, one called glial fibrillary acidic protein (GFAP), which is also associated with brain hemorrhages and traumatic brain injuries, and another called D-dimer. In this study , demonstrated that levels of these blood biomarkers combined with Field Assessment of Stroke Triage for Emergency Destinations (FAST-ED) scores could identify LVO ischemic strokes while also ruling out other conditions, such as hemorrhages in the brain. . Brain bleeds cause symptoms similar to LVO stroke, making them difficult to distinguish from each other in the field, but the treatment for each is very different.
In this prospective observational diagnostic accuracy study, researchers analyzed data from a cohort of 323 patients coded for stroke in Florida between May 2021 and August 2022. They found that combining levels of the biomarkers GFAP and D-dimer with FAST-ED Data from less than six hours from symptom onset allowed the test to detect LVO strokes with 93 percent specificity and 81 percent sensitivity. Other findings included that the test ruled out all patients with brain hemorrhages, indicating that the technology could ultimately also be employed to detect intracerebral hemorrhages in the field.
Bernstock’s team also sees promising potential future use for this accessible diagnostic tool in low- and middle-income countries, where advanced imaging is not always available. It could also be useful in the evaluation of patients with traumatic brain injuries. Next, they are conducting another prospective trial to measure the performance of the test when used in an ambulance. They have also designed an interventional trial that leverages technology to speed up the triage of stroke patients by having them bypass standard imaging and go straight to intervention.
“In stroke care, time is brain,” Bernstock said. “The sooner a patient is put on the right care path, the better they will do. Whether that means ruling out bleeding or ruling out something that needs intervention, being able to do that in a pre-hospital setting with the technology we’ve built is going to be truly transformative.” “.
Disclosures: Edoardo Guade declares a UK Research and Innovation Small Business Research Initiative grant. Edoardo Guade and Joshua Bernstock have positions and shares in Pockit Diagnostics Ltd. Joshua Bernstock also has a share position in Treovir Inc. and sits on the boards of directors of Centile Bio and NeuroX1.
Money: This study was supported by Innovate UK grant 104640 and by private funding.