Stroke is a leading cause of disability and the second leading cause of death globally. However, early intervention can prevent severe consequences, a new tool developed by researchers at Brigham and Women’s Hospital could be revolutionary in this regard.
This new test combines blood-based biomarkers with a clinical score to accurately identify patients experiencing large vessel occlusion (LVO) strokes.
“We have developed a game-changing, accessible tool that could help ensure that more people suffering from stroke are in the right place at the right time to receive critical, life-restoring care,” said Joshua Bernstock, MD, PhD, a clinical fellow in the Department of Neurosurgery at the Boston hospital.
Most strokes are ischemic, where blood flow to the brain is obstructed. LVO strokes are a severe type of ischemic stroke, occurring when a major artery in the brain becomes blocked. When the brain’s blood supply is compromised, brain cells begin to die within minutes due to a lack of oxygen, making LVO strokes a critical medical emergency. Swift treatment with mechanical thrombectomy – a surgical procedure that removes the blockage – is essential.
“Mechanical thrombectomy has allowed people, that otherwise would have died or become significantly disabled, to be completely restored, as if their stroke never happened,” explained Dr. Bernstock.
However, brain bleeds cause similar symptoms to LVO strokes, and the treatments for each are vastly different. The new test simplifies distinguishing between the two while diagnosing in the field. Here’s how they achieved this breakthrough:
The research team previously targeted two specific proteins found in capillary blood: glial fibrillary acidic protein (GFAP), associated with brain bleeds and traumatic brain injury, and D-dimer.
In their study, they demonstrated that combining the levels of these blood-based biomarkers with scores from field assessments (such as the stroke triage for emergency destination, or FAST-ED) could accurately identify LVO ischemic strokes while ruling out other conditions like brain bleeds.
“The earlier this intervention is enacted, the better the patient’s outcome is going to be. This exciting new technology has the potential to allow more people globally to get this treatment faster,” said Bernstock, senior author of the study published in the journal Stroke.
In their diagnostic accuracy study, the researchers analyzed data from 323 patients coded for stroke in Florida. They found that combining GFAP and D-dimer levels with FAST-ED scores taken within six hours from symptom onset enabled the test to detect LVO strokes with 93 patients with brain bleeds, indicating that the technology could also be used to detect intracerebral hemorrhage in the field.
Dr. Bernstock’s team envisions significant potential for this accessible diagnostic tool in low – and middle – income countries, where advanced imaging is often unbelievable. It may also be useful for assessing patients with traumatic brain injuries.
They are currently conducting another prospective trial to evaluate the test’s performance when used in ambulances. They have also designed an interventional trial to expedite stroke patient triage by bypassing standard imaging and moving directly to intervention.
“In stroke care, time is brain,” Dr. Bernstock said. “The sooner a patient is put on the right care pathway, the better they are going to do. Whether that means ruling out bleeds or ruling in something that needs an intervention, being able to do this in a prehospital setting with the technology that we built is going to be truly transformative.”
This innovative test represents a significant advancement in stroke diagnosis and treatment, potentially improving outcomes for countless patients worldwide by ensuring timely and appropriate care.
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