Frequently asked questions

Why is endovascular treatment not available in every hospital?

Endovascular treatment is an effective treatment for large vessel occlusion (LVO) strokes, but it's not available in every hospital for several reasons:

  1. Specialized Equipment and Personnel: Endovascular treatments require specific equipment and personnel with specialized training . Not all hospitals have the necessary infrastructure or trained staff, such as neurointerventional radiologists, to perform these procedures.

  2. 24/7 Availability: Endovascular procedures for stroke require around-the-clock availability of a highly specialized team including neurointerventionalists, anesthesiologists, specially trained nursing staff, and technical staff. This not only requires a significant investment in personnel but also necessitates meticulous scheduling and logistical organization to ensure the team is available at all hours.

  3. Cost: The necessary equipment and training can be very expensive, which may not be affordable for all hospitals, especially those in rural or under-resourced areas.

  4. Volume of Patients: The number of LVO stroke patients a hospital sees can also influence whether it's feasible to offer endovascular treatments. Hospitals that don't often see these types of patients might not be able to justify the expense of maintaining the necessary equipment and trained personnel. Also, treating more patients leadss to better qulaity of care.

For these reasons, stroke systems of care often incorporate both primary stroke centers, which can administer intravenous thrombolytics, and comprehensive stroke centers, which can provide endovascular treatment when needed. It is not likely that endovascular treatment will become available in every hospital.

Why do we need pre-hospital stroke triage?

Pre-hospital stroke triage is a critical component of the stroke care pathway and has several important purposes:

  1. Early Identification and Rapid Treatment: Stroke is a time-sensitive condition, and early identification and rapid treatment can significantly improve patient outcomes. In fact, the phrase "time is brain" is often used in stroke care, highlighting that every minute of delay can lead to more extensive brain damage.

  2. Appropriate Hospital Selection: Pre-hospital triage helps identify the severity and type of stroke so patients can be taken to the most appropriate hospital for their needs. For instance, patients with a suspected large vessel occlusion (LVO) stroke may need endovascular treatment, which is not available at all hospitals. In such cases, the triage process can inform the decision to transport the patient to a Comprehensive Stroke Center where this treatment is available.

  3. Advance Notification to Hospital: Pre-hospital triage can provide advance notice to the receiving hospital, allowing them to prepare resources and personnel in anticipation of the patient's arrival. This can significantly speed up the treatment process once the patient arrives at the hospital.

  4. Optimize Resource Utilization: By triaging patients and sending them to the most appropriate center for their specific needs, resources can be used more effectively, leading to more efficient care overall.

  5. Reduce Secondary Transfers: If patients are initially taken to a hospital that doesn't have the necessary facilities to treat their type of stroke, they may need to be transferred to another hospital, which can cause significant delays in treatment. Pre-hospital triage helps to reduce the need for such secondary transfers.

In essence, pre-hospital stroke triage is crucial for providing rapid, efficient, and appropriate care to patients, which can ultimately improve their outcomes and survival.

How often does a stroke occur?

According to the WHO 15 million people worldwide suffer a stroke annually. Of these, 5 million die and another 5 million are left permanently disabled, placing a huge burden on family and community.

Can you discriminate between hemorrhagic and ischemic stroke?

Hemorrhagic and ischemic strokes are two distinct types of stroke with different underlying causes.

  1. Hemorrhagic Stroke: This type of stroke occurs when a blood vessel in the brain ruptures, leading to bleeding and subsequent damage to brain tissue. The most common types of hemorrhagic stroke are intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). 

  2. Ischemic Stroke: Ischemic stroke, including LVO stroke, is caused by a blockage or obstruction in a blood vessel supplying the brain, leading to reduced blood flow and oxygenation to a specific area of the brain. EEG can help evaluate the effects of ischemic stroke on brain activity, such as detecting abnormal patterns associated with decreased brain function or areas of the brain that are not receiving sufficient blood supply.

To accurately diagnose and differentiate between hemorrhagic and ischemic strokes, medical professionals typically rely on imaging techniques such as computed tomography (CT) scans or magnetic resonance imaging (MRI) scans of the brain. Although EEG might be able to discriminate between an ischemic stroke and a hemorrhagic stroke in the future, more scientific research is required to provide a definite answer to this question.

How did you manage to acquire data in >700 suspected stroke patients?

Our extensive and significant data acquisition from over 700 suspected stroke patients has been a long-term, systematic effort at Amsterdam UMC, and it started back in 2018. At that time, we recognized the critical need for more detailed and comprehensive data on stroke patients to advance our understanding and improve the management of this life-threatening condition.

To accomplish this, we embarked on a dedicated research project which was generously supported by substantial scientific funding amounting to millions of dollars. This funding was instrumental in providing us with the necessary resources to carry out this large-scale, long-term study.

Over the course of our study, we collaborated with numerous hospitals and clinics across the Netherlands, creating a network of ambulances for data collection. With the help of over 100 trained medical professionals, we were able to meticulously document so many suspected stroke patients. 

At TrianecT we have an exclusive license to use the anonymous data collected in our scientific studies performed at Amsterdam UMC in order to get EEG-based  triage devices into the ambulance at scale.

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