Why Software Will Be the Next Big Breakthrough in Stroke Treatment

Globally, stroke is the leading cause of long-term disability and the second leading cause of death; yet, unlike other diseases with similar global impact, there are minimal options for treatment and few new options being researched. The ‘clot-busting’ drug, alteplase [tissue plasminogen activator (tPA)], was approved almost 20 years ago and represented the first big breakthrough in the treatment of ischemic stroke (where blood flow to the brain is blocked by a blood clot).

University of Calgary researchers Dr. Michael Hill, Dr. Mayank Goyal and Dr. Andrew Demchuk in the neuro-angiography suite where endovascular therapy is performed. (Riley Brandt/University of Calgary)

University of Calgary researchers Dr. Michael Hill, Dr. Mayank Goyal and Dr. Andrew Demchuk in the neuro-angiography suite where endovascular therapy is performed. (Riley Brandt/University of Calgary)

Unfortunately, tPA only works in a subset of patients and is restricted to use within a few hours of stroke onset. This drug also poses a serious risk of bleeding in people taking blood thinners, so not every ischemic stroke patient is eligible to receive this therapy.

The second big breakthrough in ischemic stroke treatment is called endovascular therapy (EVT). When performing this therapy, a neurointerventionist directs a medical device through the arteries to the clot in the brain, then physically removes it so that blood flow is restored. Last year, 5 trials of this type of treatment were published, showing that after years of failures and refinements, EVT not only works - it almost doubles the number of good outcomes than can be achieved with tPA alone:

The potential benefit of tPA and EVT are dramatically curtailed by the fact that, shockingly, only 70% of tPA-eligible, and 10% of EVT-eligible patients actually receive those therapies.

Why?

The short answer is that the expertise needed to determine a patient’s stroke type from their CT scan is in short supply. By the time it is brought to bear, many patients are outside of the short treatment window. First responders, typically Emergency physicians in community hospitals, are not trained in stroke CT analysis, and one or more consults with neurologists, stroke neurologists, radiologists and/ or neuroradiologists must follow their initial exam before a treatment path becomes clear. In particular, the stroke physician and neurointerventionist are best suited to know if a patient is eligible for EVT, and with only a few hundred of these doctors in the United States, widespread inefficiencies in triage for EVT lead to its unacceptably low rate of utilization.

The next big breakthrough in stroke treatment will be a technology that saves time, and therefore saves lives. Our approach to fighting stroke is through artificial intelligence - building a software that can see in the voxels of a CT scan what the experts who founded our company see, and use that information to speed the process of consultation and decision-making. Only a stroke specialist, or a software trained to think like one, can weigh every patient-based and imaging-based variable, and compute a treatment and triage decision swiftly enough to stop time from irreversibly affecting a patient’s outcome. A fast and accurate image analysis technology will compound the positive effects of pharmaceutical and surgical ischemic stroke treatments, ensuring that every stroke patient has a chance for the best outcome medicine can provide.