system, provides a novel approach to identifying patients experiencing large vessel occlusion (LVO) stroke with high accuracy. By combining blood-based biomarkers with a clinical score, scientists have developed a new test that could potentially prevent severe consequences of stroke.
The healthcare system, along with collaborators, has created a new test that combines blood-based biomarkers with a clinical score to accurately identify patients with large vessel occlusion (LVO) stroke. The results of their study can be found in the journal Stroke: Vascular and Interventional Neurology.
Senior author Joshua Bernstock, MD, PhD, MPH, a clinical fellow in the Department of Neurosurgery at Brigham and Women, stated, “We have developed an innovative and accessible tool that could improve the chances of getting critical, life-saving care to more stroke patients at the right place and the right time.”The majority of strokes are ischemic, meaning that they occur when blood flow to the brain is blocked. LVO strokes are a particularly aggressive type of ischemic stroke, caused by a blockage in a major brain artery. This blockage leads to a compromised blood supply to the brain, resulting in the rapid death of brain cells due to lack of oxygen and nutrients. LVO strokes are considered serious medical emergencies and require prompt treatment with mechanical thrombectomy, a surgical procedure used to remove the blockage.
The use of mechanical thrombectomy has proven to be life-saving for individuals who would have otherwise died or suffered severe disability. It has the ability to fully restore these individuals, as if the stroke had never occurred.”The sooner this intervention is implemented, the better the patient’s chances are,” stated Bernstock. “This innovative technology has the ability to make this treatment more accessible to people worldwide.” The researchers had previously focused on two particular proteins present in capillary blood, one known as glial fibrillary acidic protein (GFAP), associated with brain bleeds and traumatic brain injury, and another called D-dimer. Through their study, they showed that the levels of these blood-based biomarkers, in combination with field assessment stroke triage for emergency destination (FAST-ED) scores, could have a significant impact.The goal of this study was to distinguish LVO ischemic strokes from other conditions such as brain bleeding, which have similar symptoms. It can be difficult to differentiate between the two in the field, but it is important to do so because the treatment for each condition is very different.
Researchers conducted a prospective, observational diagnostic accuracy study using data from 323 stroke patients in Florida between May 2021 and August 2022. They discovered that by combining levels of biomarkers GFAP and D-dimer with FAST-ED data within six hours of symptom onset, the test was able to identify LVO strokes with 93 percent specificity.and 81 percent sensitivity. In addition, the study found that the test successfully eliminated all patients with brain bleeds, suggesting that the technology may eventually be used to identify intracerebral hemorrhage in the field.
Bernstock’s team also envisions potential future applications of this accessible diagnostic tool in low- and middle-income countries, where advanced imaging is not always accessible. It could also be valuable in evaluating patients with traumatic brain injuries. They are currently conducting another prospective trial to assess the test’s performance when used in an ambulance. They have also developed an interventional trial that l rnrnLeveraging technology can help speed up the process of identifying and treating stroke patients by allowing them to skip standard imaging and go straight to intervention. According to Bernstock, time is crucial in stroke care, and getting patients on the right care path as soon as possible can greatly improve their outcomes. The ability to rule out bleeds or identify issues that require intervention in a prehospital setting using the technology they have developed could be revolutionary. Disclosure: Edoardo Guade has received grant funding from the UK Research and Innovation small business research initiative. Edoardo Guade and Joshua Bernstock are affiliated with Pockit Diagnostics Ltd. and have equity positions in the company. Joshua Bernstock also holds an equity position in Treovir Inc. and serves on the boards of Centile Bio and NeuroX1.
Funding: The study received support from Innovate UK grant 104640 and private funding.
