CHI Memorial’s Stroke and Neuroscience Center participated in the national research study, BUBL, and was instrumental in developing novel technology that can better detect a specific cause of brain damage in some stroke victims. Insights gleaned from this landmark study have finally unraveled the mystery of why the cause of stroke has been so elusive for so many stroke patients, particularly young patients. Advancements in stroke care have enabled an ever-increasing number of patients to survive after suffering a stroke; however, the post-stroke population remains at high risk of having another stroke. Understanding the cause of a stroke, including the role of heart-related conditions, is critical to providing appropriate treatment.
The technology used in the study is robotic transcranial Doppler (TCD) ultrasound from NovaSignal. Results of the study show TCD ultrasound is three times as good as conventional cardiac testing at identifying cardiac abnormalities capable of producing blood clots that cause stroke.
“Understanding the underlying cause of a stroke allows us to deliver far more effective therapy to prevent another stroke,” said Thomas Devlin, MD, PhD, FSVIN, neurologist, medical director of CHI Memorial Stroke and Neuroscience Center, and co-director of CommonSpirit’s national neuroscience collaborative. “After seeing the positive impact delivered by TCD ultrasound in our practice, it became clear to both our brain and heart doctors that it must be incorporated into our practice as a new standard of care.”
The cardiac abnormality in question is a “right-to-left shunt (RLS)”, a known risk factor for stroke as it provides a conduit for a clot to travel to the brain. A patent foramen ovale (PFO), also known as a hole in the heart, is the most common source of a RLS and is present in more than 40 percent of cryptogenic stroke (stroke without a known cause) patients.
The TCD ultrasound technology used in this study combines non-invasive ultrasound, robotics, and artificial intelligence to assess cerebral hemodynamics, or blood flow, in real time. It detected three times the number of PFOs when compared with conventional heart ultrasound (63.6% vs 20.2%, p<0.001). Of the PFOs detected, the technology discovered nearly three times the number of large shunts, or abnormal blood flow patterns, that could be corrected with surgery (27.8% vs 10.3%, p=0.002).
CHI Memorial is part of CommonSpirit Health, one of the country’s largest nonprofit health care networks. Clinical leaders will be working to train providers and implement this new approach to stroke diagnosis and care across CommonSpirit’s 138 hospitals.
“The results of our research program represent a milestone in stroke medical care,” explained Ruchir Shah, MD, CHI Memorial stroke program medical director. “We anticipate this new standard of medical care will save many lives by preventing future strokes.”
“Given that stroke is the number one cause of adult disability in the United States, the ability to more accurately diagnose the cause of stroke is of utmost importance,” said Janelle Reilly, market CEO, CHI Memorial. “We are excited that our research partnership has led to the development of a novel technology that will have a huge impact at reducing risk of secondary stroke benefiting patients both within the CommonSpirit network and well beyond”.
The medical research from the BUBL study was recently presented at the International Stroke Conference in Dallas.
Disclosure: Dr. Devlin has equity interest in NovaSignal.