Envisioning the streamlined stroke care system of tomorrow
- By Philips
- October 30 2024
- 10 min read
Every second counts to an individual experiencing a stroke. The urgency for medical intervention becomes critical. 1 in 4 adults over 25 will have a stroke in their lifetime.1 The journey to revolutionize stroke care is both a challenge and an urgent need. Advancements in stroke treatment, like mechanical thrombectomy (MT), are poised to transform outcomes for acute ischemic stroke patients. Widespread adoption of these innovations requires rethinking current protocols. This article focuses on the challenges and innovations that promise to redefine the landscape of neurovascular care.
At-a-glance:
- Explore clinical and technological trends shaping the treatment of stroke
- Review persistent challenges and gaps that slow progress
- Discuss opportunities to streamline stroke care pathways
- Discover what the future of stroke care could be
Trends transforming the landscape of stroke care
Several key trends are converging to drive transformation in stroke management.
Mechanical thrombectomy emerges as the gold standard. Multiple clinical trials have proven MT's efficacy for treating large vessel occlusions.2 It's increasingly becoming the first-line therapy, much like how percutaneous coronary intervention (PCI) evolved for heart attack treatment. Stroke systems of care are being reorganized into hub-and-spoke networks of primary stroke centers feeding cases to thrombectomy-capable comprehensive stroke centers.
Advanced imaging enables personalized treatment selection. New imaging capabilities are shifting the paradigm from time-based to tissue-based patient selection. CT perfusion and MRI allow doctors to identify salvageable brain tissue and customize thrombectomy decisions for each patient, even beyond the traditional time windows. Artificial intelligence (AI) is also being applied to automatically detect large vessel occlusions on CT angiography, streamlining the triage process.
Extended time windows expand treatment eligibility. Based on landmark trials such as DAWN and DEFUSE 3, guidelines now support thrombectomy up to 24 hours after stroke onset in carefully selected patients with favorable imaging profiles.3 This is vastly increasing the population eligible for endovascular therapy. More inclusive selection criteria are being explored to bring the benefits of thrombectomy to additional patient groups.
Prehospital and intrahospital workflow innovations boost efficiency. Novel pathways, such as mobile stroke units and the Direct-to-Angio Suite approach, aim to eliminate delays and shuttle patients straight to the thrombectomy suite upon hospital arrival. Improved team communication, data sharing and parallel processing are further shaving off precious minutes. These workflow enhancements are critical to realizing thrombectomy's potential.
Optimizing angio suite design and technologies. Purpose-built angio suites and technologies tailored for neuroradiology interventions are creating a more efficient clinical environment. Cutting-edge imaging capabilities, like cone-beam CT and 3D navigation guidance, assist the physician. Newer generations of thrombectomy devices achieve higher rates of complete revascularization. These refinements all contribute to better technical and clinical outcomes.
Mechanical thrombectomy is revolutionizing acute ischemic stroke treatment, much like how PCI evolved the standard of care for heart attacks.
Persistent challenges and gaps slow progress
Despite the remarkable strides made, significant headwinds are hampering our ability to make thrombectomy accessible to all who could benefit.
Lack of public awareness delays treatment
Stroke signs often go unrecognized by patients and bystanders, postponing medical contact until it's too late. In fact, this unawareness is one of the leading causes of delay in seeking medical attention. One study found that 42% of patients presenting with acute ischemic stroke were not treated due to admission outside the ideal treatment window for reperfusion therapy.4 Public education campaigns about stroke symptoms and the need to activate emergency services immediately are crucial.
Uncertainty in prehospital diagnosis and triage
First responders, such as paramedics, are not always equipped or empowered to confidently diagnose strokes in the field. Valuable time is lost in transporting patients to stroke-capable hospitals. Ambulance-based telestroke assessments and AI diagnostic aids could help get more patients to the right center the first time.
Shortages of thrombectomy-capable facilities and specialists
Delivering 24/7 thrombectomy services requires substantial investment in infrastructure, staff, training, call coverage and care coordination. Currently, fewer than 5% of stroke patients globally receive adequate and timely treatment.5 Building out more comprehensive stroke centers and developing additional specialists will be necessary to meet the growing need.
Fewer than 5% of stroke patients globally receive adequate and timely treatment, a failure that health leaders could help rectify with the right system-level changes.
Barriers to data integration and care coordination
Stroke care depends on seamless collaboration across a large multidisciplinary team spanning prehospital, hospital and post-acute settings. However, incompatible data systems often create silos between these providers. Centralizing data from EMS, imaging, angio suites and registries could facilitate more integrated, efficient stroke care.
Uncertainty about long-term impacts on stroke survivors
Even as more patients survive strokes thanks to advanced therapies, the long-term effects on their quality of life are not fully understood. Many individuals still face significant disabilities and require ongoing support. More research is needed on how thrombectomy affects long-term functional outcomes and which post-stroke interventions can maximize recovery.
Seizing opportunities to accelerate progress in treating stroke
To realize MT's full potential to reduce death and disability from stroke, we must invest in proven strategies and promising innovations. Collective and coordinated efforts from health system leaders, interventional neuroradiologists, policymakers, industry partners and technology vendors can combine to lead to a healthier future.
Boost public awareness and early recognition
Educating the public to spot stroke symptoms and call emergency services immediately is the first domino in the chain of survival. The FAST mnemonic acronym (facial drooping, arm weakness, speech difficulty and time to call 911) is a simple but effective way to empower caregivers and bystanders as the first link in stroke care.
Accelerate prehospital diagnosis and triage
Providing EMS teams with better training and tools for prehospital stroke recognition can avoid delays and misrouting. Mobile telestroke platforms allow ambulance crews to patch in stroke experts for remote assessments. AI algorithms can analyze ambulance ECGs and CT scans to identify large vessel occlusions worthy of direct thrombectomy center transport.
Expand availability of thrombectomy centers and specialists
Developing thrombectomy-capable stroke centers in underserved areas will be key to expanding access. Initiatives like the European Union's Stroke Action Plan aim to boost the number of people living within 45-60 minutes of an MT center and implement national strategies for enhancing care from primary prevention to post-stroke management.6 Cross-training other medical specialties, such as interventional radiologists, neurosurgeons and cardiologists, to perform thrombectomies could also help alleviate the shortage of neurointerventionalists.
Streamline in-hospital workflows and technical approaches
Innovative pathways like the Direct-to-Angio Suite model, which bypasses the emergency department and brings stroke patients straight to imaging and intervention, are reducing times to treatment.7 Refinements in angio suite design and thrombectomy technologies now yield faster recanalization and better outcomes. Ongoing trials will identify the optimal technical approaches.
Integrate multidisciplinary data systems and communication
Interconnected data platforms that unite information from the ambulance, imaging lab, angio suite and post-acute facilities can streamline care coordination and improve quality. A central dashboard displaying key timestamped metrics for every case allows teams to analyze their performance in real time. Cloud based repositories enable the sharing of imaging and outcomes data between centers.
Support stroke survivors' lasting recovery and reintegration
As a chronic disease, stroke requires long-term management to help survivors regain function and resume meaningful roles. Early mobilization, intensive rehab, psychological support and vocational training all contribute to maximizing independence. Mobile technologies can extend rehabilitation into the home. Studying thrombectomy patients longitudinally will highlight how the procedure affects quality of life.
By optimizing protocols, leveraging technology and collaborating as a multidisciplinary team, we can deliver the right treatment to the right patient at the right time.
Building a promising future for stroke care
Armed with these strategies, we can redesign our systems of care to revolve around fast, widely accessible MT treatment. The future is a streamlined, efficient pathway where:
- Public awareness campaigns spur rapid recognition of stroke signs and emergency activation.
- Ambulance crews quickly identify severe strokes using AI diagnostic support and route patients directly to thrombectomy centers when indicated.
- Paramedics send ahead key information so hospital teams can be ready upon arrival. Stroke neurologists perform remote triage assessments via telestroke tools.
- Patients transfer straight from the ambulance to the angio suite, bypassing the emergency department. The interventional neuroradiology team stands prepared to immediately start the procedure.
- Using advanced 3D imaging guidance and the latest device technology, specialists achieve complete revascularization on the first pass.
- After thrombectomy, patients recover in dedicated neuro ICUs staffed by experts in preventing complications. Rehabilitation starts early to promote the best possible functional outcomes.
- A central data integration platform unites information from every stage of care, powering continuous quality improvement and research. Cloud-based registries allow comparing performance between centers.
- Discharged patients can continue intensive rehab at home through novel digital platforms. Mobile apps support medication adherence, lifestyle modification and complication monitoring.
- Long-term follow-up assesses functional status, mental health and reintegration. This data is cycled back to refine protocols and track quality of life.
In this future state, MT is the rule rather than the exception for severe strokes. Coordinated emergency response and optimized in-hospital processes make the treatment available 24/7 to every appropriate patient. With earlier recognition, faster treatment and advanced technologies, rates of successful revascularization will rise. Seamless transitions to intensive rehabilitation and long-term support maximize the benefits to patients' quality of life. And keeping patients and families at the center can ensure care delivery that truly matters.
This vision is ambitious but attainable. Through the concerted efforts of interventional neuroradiologists collaborating with the broader stroke community, streamlined systems of stroke care can be built. The road ahead is challenging, but the opportunity is immense. Every advancement in stroke care, whether incremental or groundbreaking, translates to lives saved and futures restored. By organizing our services to deliver fast, effective treatments to all eligible patients, we can dramatically reduce stroke's devastating toll.
To learn more about how you can leverage the latest protocols, technologies and team-based approaches to optimize care delivery, explore our neurovascular care portfolio and specific clinical solutions for treating ischemic stroke.
When it comes to stroke, every second matters.
Stroke care system of the future - Infographic
- Impact of Stroke, World Stroke Organization
- Katano T, Suzuki K, Kimura R, Saito T, Nishiyama Y, Kimura K. Mechanical Thrombectomy Treatment More than 16 h after Last Known Well for Patients with Large Vessel Occlusion. Cerebrovascular Diseases Extra. 2023;13(1):69-74. doi: https://doi.org/10.1159/00053115
- Nannoni S, Strambo D, Sirimarco G, et al. Eligibility for late endovascular treatment using DAWN, DEFUSE-3, and more liberal selection criteria in a stroke center. Journal of NeuroInterventional Surgery. 2019;12(9):842-847. doi: https://doi.org/10.1136/neurintsurg-2019-015382
- Behrndtz AB, Damsbo AG, Blauenfeldt RA, Andersen G, Speiser LO, Simonsen CZ. Too risky, too large, too late, or too mild—Reasons for not treating ischemic stroke patients and the related outcomes. Frontiers in Neurology. 2022;13. doi: https://doi.org/10.3389/fneur.2022.1098779
- Saini V, Guada L, Yavagal DR. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology. 2021;97(20 Supplement 2):S6-S16. doi: https://doi.org/10.1212/WNL.0000000000012781
- Stroke Action Plan for Europe - European Stroke Organization. Published November 20, 2019. Accessed May 22, 2024. https://eso-stroke.org/projects/stroke-action-plan/
- Requena M, Olivé-Gadea M, Muchada M, et al. Direct to Angiography Suite Without Stopping for Computed Tomography Imaging for Patients With Acute Stroke: A Randomized Clinical Trial. JAMA Neurology. 2021;78(9):1099-1107. doi: https://doi.org/10.1001/jamaneurol.2021.2385