A team of researchers led by investigators from Brigham and Women’s Hospital and collaborators has developed a groundbreaking test that combines blood-based biomarkers with a clinical score to accurately identify patients experiencing large vessel occlusion (LVO) stroke. This aggressive type of ischemic stroke, caused by a blockage in a major brain artery, requires swift treatment with mechanical thrombectomy to restore blood flow and prevent severe consequences.
The study, published in the journal Stroke: Vascular and Interventional Neurology, demonstrates the potential of this accessible diagnostic tool to ensure more stroke patients receive critical, life-restoring care in a timely manner. “We have developed a game-changing, accessible tool that could help ensure that more people suffering from stroke are in the right place at the right time to receive critical, life-restoring care,” said senior author Joshua Bernstock, MD, PhD, MPH, a clinical fellow in the Department of Neurosurgery at Brigham and Women’s Hospital.
Combining Blood Biomarkers and Clinical Scores for Accurate Diagnosis
The research team targeted two specific proteins found in capillary blood: glial fibrillary acidic protein (GFAP), which is also associated with brain bleeds and traumatic brain injury, and D-dimer. They demonstrated that the levels of these blood-based biomarkers, combined with field assessment stroke triage for emergency destination (FAST-ED) scores, could identify LVO ischemic strokes while ruling out other conditions such as brain bleeds.
In a prospective, observational diagnostic accuracy study involving a cohort of 323 patients coded for stroke in Florida between May 2021 and August 2022, the researchers found that combining GFAP and D-dimer levels with FAST-ED data less than six hours from the onset of symptoms allowed the test to detect LVO strokes with 93 percent specificity and 81 percent sensitivity. Notably, the test ruled out all patients with brain bleeds, signaling its potential to detect intracerebral hemorrhage in the field.
Transforming Stroke Care and Expanding Access
The accessibility of this diagnostic tool holds promise for use in low- and middle-income countries, where advanced imaging is not always available. It may also prove useful in assessing patients with traumatic brain injuries. Bernstock’s team is currently conducting another prospective trial to measure the test’s performance when used in an ambulance, as well as an interventional trial that leverages the technology to expedite the triage of stroke patients by bypassing standard imaging and moving directly to intervention.
“In stroke care, time is brain,” Bernstock emphasized. “The sooner a patient is put on the right care pathway, the better they are going to do. Whether that means ruling out bleeds or ruling in something that needs an intervention, being able to do this in a prehospital setting with the technology that we built is going to be truly transformative.”
As this groundbreaking test continues to undergo rigorous testing and refinement, it holds the potential to revolutionize stroke care by enabling rapid, accurate diagnosis and timely treatment, ultimately saving lives and reducing the devastating consequences of this leading cause of disability worldwide.
