Introducing Innovative Technologies Into Stroke Standard of Care

July 27, 2019

The co-director of the Gates Stroke Center and Cerebrovascular Surgery at Kaleida Health and director of endovascular stroke treatment and research medical director of neuroendovascular services at Gates Vascular Institute spoke about unmet needs in stroke and the value of introducing innovative technologies into the space.

Elad Levy, MD, MBA

At the 16th annual Society of NeuroInterventional Surgery Annual Meeting, Viz.ai and Medtronic announced a partnership to expand access to Viz.ai’s AI-based technologies to help synchronize stroke care and decrease time to treatment.

Viz.ai’s software connects to hospital CT scanners and alerts stroke specialists that a suspected large vessel occlusion has been identified, sending radiological images directly to physician smartphones, enabling them to provide treatment immediately.

Elad Levy, MD, MBA, co-director of the Gates Stroke Center and Cerebrovascular Surgery at Kaleida Health and director of endovascular stroke treatment and research medical director of neuroendovascular services at Gates Vascular Institute at the State University of New York at Buffalo, spoke with NeurologyLive in an interview to discuss the value of introducing innovative technologies into stroke standard of care.

NeurologyLive: Can you discuss the unmet needs in stroke care and some of the challenges with treatment?

Elad Levy, MD, MBA: There are 2 unmet needs. One is patient education, I think everybody knows what a heart attack feels like, chest pain, jaw pain, even arm pain, but stroke symptoms are more complex so it could be speech, numbness, motor weakness, or change in consciousness, so I think one of the unmet needs right now is educating patients on the signs and symptoms of stroke and the urgency. Sometimes people think they're going to sleep this off or are just going to wait a bit, but educating signs and symptoms and then educating the patient that they need to get to the nearest stroke center, not just any hospital, but hospitals that are actually equipped to treat strokes at a minimum with TPA if it's in the window, or hopefully they're near comprehensive stroke centers that can use catheter-based treatments.

The other unmet need is really geography, so while certain cities and certain populations may have an excess of interventionalists that are trained in stroke treatments they're significant populations that geographically are remote from centers that offer catheter-based interventions, so unfortunately there's access to these centers which require sometimes time and that time unfortunately decreases the potential number of patients that may still benefit from catheter-based treatment.

What is the value of introducing innovative technologies into standard of care?

Right now the tools that we use for intervention have been developing rapidly and continue to be iterated, so while we can now bring even larger-bore catheters much further into the circulation, our recanalization rates consistently in some centers are now 90% or better especially when using combination stent retrievers and aspiration, so really the ability to design aspiration catheters that have large inner diameters and they're soft, supple and navigable allows clinicians to get these large-bore aspiration catheters right up into the clot and aspirate the clot directly, where only a few years ago weren’t able to drive such large catheters into the middle cerebral artery or other distal locations.

How has digital technology advanced standard of care?

I think digital technology, for example, like Viz.ai, allows the stroke team to be notified within minutes of patients getting off of a CAT scanner, so let's say somebody gets scanned at a remote hospital, we need a radiologist to potentially read it, notify the ER doctor, the ER doctor will then get on phone and try to call a stroke team, and maybe it’s a plain CT, but members of the stroke team that are on call are notified directly, and I can see the images immediately on my phone from where I am, I don’t have to wait to log into a desktop and I can not only get the anatomy, I can understand the physiology and now we can be proactive, we can be in the driver's seat, the stroke team can be proactive to call the outside facilities and say hey send the patient to the comprehensive stroke center, and we are activating the stroke team while the patients is on route, meet the patient in ER, and then effectively really reducing the interval between stroke onset and treatment.

How has telestroke played a role in helping to reduce time to treatment?

Telestroke, similarly, is excellent and we've been involved in telestroke programs for over a decade, so using a hub-and-spoke model where the comprehensive stroke care center is the hub, we can do patient exams via telestroke at the other facility, but at the same time, the one downside with telestroke is while we can see the patient there and examine the patient there and have access to the imaging there through telestroke, often we need that spoke hospital to initiate the call. A patient may come into a spoke hospital, with what may be a stroke, they then get the scan, the stroke team is then waiting for the spoke hospital to call the hub where I think current technologies such as Viz.ai and potentially others, it sort of flips the initiation and we're not waiting for anyone to notify us, we’re notified and then we can make the call proactively, so basically effectively flipping the stroke team into the driver's seat.

Telestroke is still a fantastic application, one doesn't obviate the need for the other, so with telestroke I can look at that patient and examine them and potentially start initiating treatment at the remote facility prior to them the initiating transfer to the hub hospital.

What is the benefit of AI technology in stroke care?

Viz.ai provides both the anatomy for the plain CAT scan as well as where the location of the clot is through CT angio. We get we can also see brain physiology through the perfusion maps, but it also gives you real-time what I call “real time fingerprints” where we can see who's accessing the file, what's been initiated, and basically can create a chat or linking of communication between everybody who is involved in the care of that patient, so I can see who's looked at the scan, I can see if they document treatment, what medications have been given, and basically we have a chronology of fingerprints of care for that patient.

Transcript has been edited for clarity.